What is the treatment of chronic nonhealing fissures associated with constipation?

Updated: Mar 30, 2020
  • Author: Marc D Basson, MD, PhD, MBA, FACS; Chief Editor: BS Anand, MD  more...
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Chronic nonhealing fissures may be managed with topical nitroglycerin or botulinum toxin injections with reasonable success. However, the long-term recurrence rate after such therapy has yet to be established. Many of these patients may require surgical sphincterotomy. Uncontrolled anal dilation has become less popular than sphincterotomy because of concerns over an increased risk of sphincter injury. A colorectal surgeon should be consulted for patients with chronic fissures to evaluate the need for surgical intervention and to consider biopsy of the fissure to rule out malignancy.

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