Anal Fissure and Anal Stenosis

Anal fissure is a common perianal condition. When fissures persist for more than 6 weeks, they are considered chronic. First-line treatments include conservative management and pharmacologic therapy with topical calcium blocker ointments. Botulinum toxin is gaining favor as a second-line treatment with lateral internal sphincterotomy representing the surgical standard with the highest healing rates. Anal stenosis is an uncommon however potentially serious condition that is characterized by abnormal narrowing of the anorectal junction, anal canal, or the anal margin. It can be classified as congenital, primary, or secondary. Nonoperative management is reserved for mild cases, while surgical procedures for moderate and severe cases including sphincterotomy, stricturotomy, stricturectomy, and appropriate flap anoplasty may be considered.