Conservative Management Failure in The Treatment of Acute Fissure-in-Ano

Sufyan Taufiq, Dileep Kumar, Irfan Ali, Saib, Qandeel Fatima, Sonia Rani Channar

Abstract

Objective

To determine the frequency of conservative management failure among acute fissure-in-ano patients presenting to a tertiary care hospital.

Study design

Cross sectional observational study.

Place & Duration of study

Department of General Surgery, Unit-1, ward-3, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from June 2025 to December 2025.

Methods

A total of 120 patients  between 18 to 60 years of age with a clinical diagnosis of acute fissure-in-ano of less than six-weeks duration were enrolled by non-probability consecutive sampling. Patients with chronic fissure and those associated with anorectal diseases and had previous surgery were excluded. Standardized conservative management including dietary fiber supplementation, increased fluid intake, sitz baths, topical lignocaine gel application thrice a day as well as diltiazem gel 2% twice a day was advised to all the patients over a period of six weeks. The follow-up evaluation was done at week 2 and 6. Failure of treatment was considered as a continuation of symptoms with no fissure healing on local examination. The SPSS version 26 was used to analyze the data.

Results

Out of the total, 78 (65%) were male and 42 (35%) female patients with a mean age of 38.4 ± 10.2 years. The most frequent presenting complaints included painful defecation and fresh rectal bleeding. Mean baseline Visual Analogue Scale (VAS) score was7.1±1.3. In 89 (74.2%) patients fissure was completely healed at six weeks, while in 31(25.8%) symptoms persisted. Failure of treatment was more common in male patients, with a higher baseline pain score and the duration of the symptoms (p < 0.05). No significant conservative therapy related complications were noted.

Conclusion

In majority of the patients with acute fissure-in-ano, conservative management was effective. Non-responders should be identified early so as to avoid chronicity and a cutoff of six weeks is an ideal period.

Key words

Acute anal fissure, Conservative management, Fissure-in-ano, Diltiazem, Lignocaine.