Analfissur

Anal fissures are one of the most frequent proctological diseases. Typically, patients suffer from severe anal pain during and after defecation. The treatment is primarily conservative. The majority of fissures heal with this and the additional local application of calcium channel blockers or nitrates. A surgical procedure can only be considered if conservative/drug treatment lasting several weeks does not lead to any improvement in symptoms; however, the risk of postoperative fecal incontinence must be taken into account so that the indications for surgery should be considered extremely cautiously in patients with weak sphincter tone. The surgical procedure of choice in Germany is fissurectomy, possibly with defect covered by an advancing flap. Botulinum toxin is currently not intended for first-line treatment of anal fissures. According to the guidelines there is a “can do” recommendation as a second-line treatment alternative to surgery.