Anal fissure.Single or multiple tears of the anal skin usually result from the passage of large, constipated stools. Acute anal pain and superficial bleeding may result. Spasm of the anal sphincter may lead to a vicious circle of worsening constipation and failure of the fissure to heal. Local anaesthetic creams are normally prescribed, and topical nitrate creams and local botulinum toxin injections have been tried. Operative stretch of the anal sphincter under general anaesthesia may be indicated for some patients.
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