A combined surgical and pharmacological treatment, administered by colorectal surgeons, is the direct injection of botulinum toxin (Botox) into the anal sphincter to relax it. This treatment was first investigated in 1993. However, in many cases involving Botox injections, the patients eventually had to choose another cure as the injections proved less and less potent, spending thousands of dollars in the meantime for a partial cure. Lateral sphincterotomy is the Gold Standard for curing this condition. Combination of medical therapies may offer up to 98% cure rates. Surgery
Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for at least one to three months and have not healed. It is not the first option in treatment. The main concern with surgery is the development of anal incontinence. Anal incontinence can include the inability to control gas, mild fecal soiling, or loss of solid stool. Some degree of incontinence can occur in up to 45 percent of patients in the immediate surgical recovery period. However, incontinence is rarely permanent and is usually mild. The risk should be discussed with ones surgeon. Surgical treatment, under general anaesthesia, was either anal stretch (Lords operation) or lateral sphincterotomy where the internal anal sphincter muscle is incised. Both operations aim to decrease sphincter spasming and thereby restore normal blood supply to the anal mucosa. Surgical operations involve a general or regional anaesthetia. Anal stretch is also associated with anal incontinence in a small proportion of cases and thus sphincterotomy is the operation of choice.
In addition, anal stretching can increase the rate of flatus incontinence. The incidence of incontinence is thought to be due to a lack of standardization and that proper technique results in little chance that it will occur.In the early 1990s, however, a repeatable method of anal dilation proved to be very effective and showed a very low incidence of side effects. Since then, at least one other controlled, randomized study has shown there to be little difference in healing rates and complications between controlled anal dilation and LIS, while another has again shown high success rates with anal dilation coupled with low incidence of side effects. Fissurectomy
Fissurectomy involves excision of the skin on and around the anal fissure and excision of the sentinel pile if one is present. The surgical wound can be left open. New skin tissue grows and it heals. Epidemiology
The incidence of anal fissures is around 1 in 350 adults. They occur equally common in men and women and most often occur in adults aged 15 to 40. See also
Anal fistula
Hemorrhoid
Pruritus ani

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