role of manual dilation of the anus in the management of anal fissures

ABSTRACT

This work was done on 50 cases of anal fissure to study the role of manual dilatation of the anus [5 fingers] under general anesthesia as an office procedure in the outpatient clinic in the management of this disease. They were divided into three groups Group I, 20 cases of acute anal fissure, group II, 20 cases of chronic anal fissure and group III, 10 cases of chronic anal fissure associated with hemorrhoids. The success rate was 95% in group I, 75% in group II and 70% in group III. Persistence of skin tag was found in 50% of group II and 40% of group III. Prolapse of internal hemorrhoids occurred in two cases of group III one of them underwent thrombosis [10%]. Dysfunction of the anal sphincter was temporary and disappeared in 6 months. Manual dilatation of the anus [MDA] is recommended as the method of choice in the management of acute anal fissure and as a good first method for the management of chronic fissures to be followed by a formal operation in cases of non response and in should be used cautiously in chronic fissures associated with hemorrhoids