Treatment of Anal Fissure with Low (Hypotensive) Anal Sphincter Pressure
This protocol covers anal fissure presenting alongside low anal sphincter pressure — pressures below the range considered normal clinically or on anorectal manometry. In this setting, fissures may be anteriorly located or present as multiple lesions.
Clinical Scenario
Anal fissure with low (hypotensive) anal sphincter pressure; possibly anteriorly located or multiple. The sphincter pressure profile, established clinically or manometrically, defines this sub-population and directly shapes the management pathway.
Management Approach
For this specific pressure profile, the structured protocol involves a neuromodulatory approach. The full protocol — including the precise modality, patient selection criteria, and sequencing — is available via the link below.
References
DOI: 10.1111/codi.167
Low pressure – anal sphincter pressures below that considered within normal range clinically and or manometrically.
For patients with low sphincter pressure-type anal fissures, biofeedback may be considered.
For patients with low sphincter pressure-type anal fissures, if biofeedback fails neuromodulation may be considered.
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