This protocol applies to male patients with a chronic anal fissure that has not resolved following an initial course of laxatives and topical therapy.

Clinical scenario

Male sex with chronic anal fissure persisting despite prior treatment with laxatives and topical therapy. In this group, conservative measures have been insufficient and escalation of management is indicated.

Treatment approach

For male patients in this scenario, a surgical procedure targeting the internal sphincter is the approach to consider. Patient-specific factors, including preferences and continence status, guide the selection among available options.

The complete decision pathway, specific procedure details, and eligibility criteria are available in the full structured regimen.

Treatment goal: Healing of the fissure

References

DOI: 10.1111/codi.167

For male patients with chronic fissure persisting after laxatives and topical therapy, a lateral internal sphincterotomy should be considered.
In male patients with chronic anal fissures having lateral internal sphincterotomy, a sphincterotomy to the dentate line may be considered.
For male patients with chronic fissure persisting after laxatives and topical therapy, who do not want sphincter division or have continence issues, botulinum toxin may be considered.

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Chronic Anal Fissure in Male Patients Persisting After Laxatives and Topical Therapy

References