Results of Medical Treatment in Acute Anal Fissure
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Background: Acute anal fissure is commonly associated with sphincter hypertonicity, pain, and bleeding, and conservative treatment aims to promote healing while avoiding operative sphincter injury. Objective: To compare anal self-massage with passive progressive anal dilatation for the treatment of acute anal fissure. Methods: This prospective randomized comparative study included 50 patients with acute posterior anal fissure allocated equally to self-massage (Group A) or progressive anal dilatation (Group B). Clinical healing, pain, bleeding, itching, burning, adverse effects, and recurrence were assessed at treatment completion and at 3 and 6 months. Categorical comparisons were evaluated using Fisher's exact test. Results: Complete fissure resolution occurred in 20/25 patients (80.0%) in Group A and 15/25 (60.0%) in Group B (RR 1.33, 95% CI 0.92–2.04; p=0.217). At 6 months, persistent anal pain was significantly less frequent in Group A than Group B (20.0% vs 56.0%; p=0.019). Six-month recurrence among initially healed patients was 5.0% and 20.0%, respectively (p=0.292). Bleeding, itching, and burning were numerically less frequent with self-massage but did not differ significantly between groups. No treatment-related adverse effects were reported. Conclusion: Anal self-massage produced favorable clinical trends and significantly less persistent pain at 6 months, but differences in complete healing and recurrence were not statistically significant
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