Anal fissure are one of the most painful conditions seen in surgical practice. Fissures develop from a tear in the lining of the anal mucosa, as a result of straining or constipation. Because of the exquisitely sensitive nature of the lining of the anal canal, fissures, or tears in the skin are typically incapacitating. Standard treatment includes a fiber supplement, copious fluids and topical smooth muscle relaxant such as nitroglycerin or nifedipine cream. Smooth muscle relaxants reduce pressure generated by the internal sphincter muscle, so minimizing pain during defecation.
If non surgical treatment of fissures fails, then conservative sphincter-sparing surgery may be appropriate. Typically, surgeons divide the internal sphincter muscle during surgey, to relax the muscle and reduce discomfort. Research by dr Armstrong has demonstrated that removing scar tissue, tethering the fissure, relaxes the anal canal sufficiently so that the internal sphincter need not be divided. This avoids potential problems with anal incontinence, and other problems such as fistulas. The research performed was published in the surgical journal Dis Colon Rectumin 2013.