What is the role of the posterior anal commissure in the pathophysiology of anal fissure?

Updated: Jul 24, 2020
  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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The posterior anal commissure is the most poorly perfused part of the anal canal. In patients with hypertrophied internal anal sphincters, this delicate blood supply is further compromised, thus rendering the posterior midline of the anal canal relatively ischemic. This relative ischemia is thought to account for why many fissures do not heal spontaneously and may last for several months.

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