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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lateral sphincterotomy is probably the operation of choice for most cases of intractable anal fissure in children. The lower half of the sphincter is divided in the left or right lateral position through a small external incision at the anal verge. An incision in the anal canal itself is avoided, postoperative pain is minimal and the risk of secondary hemorrhage is eliminated. The operation can be done as an outpatient procedure. Only one patient developed minor anal incontinence.
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PMID:Lateral subcutaneous internal sphincterotomy for anal fissure. Technic and experience with 22 cases in children. 112 73

A prospective study comparing open and subcutaneous lateral internal sphincterotomy for chronic anal fissure was conducted. One hundred twelve patients were randomized to open (n = 54) or subcutaneous (n = 58) sphincterotomy. There was no significant difference in acute complications between the subcutaneous (8.6 percent) and open (7.4 percent) groups. Postoperative length of stay was significantly shorter for the subcutaneous group (1.7 +/- 0.2 days) than for the open group (2.3 +/- 0.1 days; P less than 0.001). Although the response rate to a pain questionnaire was less than 50 percent, the data suggest a lower level of postoperative pain in the subcutaneous group. Fissure healing was similar between the subcutaneous (96.6 percent) and open (94.4 percent) groups. We conclude that subcutaneous lateral internal sphincterotomy for chronic fissure-in-ano is effective and may result in significantly less postoperative discomfort, shorter postoperative lengths of stay, and a comparable rate of complications compared with the open technique.
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PMID:Chronic fissure-in-ano: a randomized study comparing open and subcutaneous lateral internal sphincterotomy. 151 41

The pressure measurements and clinical sensation of 11 patients with hemorrhoids and 8 patients with posterior and fissure were analyzed before and after the topical administration of an anesthetic gel containing tetracaine in the anal canal. A significant increase of the maximal basal pressure (p less than 0.01) was observed in comparison with a control group of the same age and sex. No differences in the maximal pressure of voluntary contractions. The anesthetic gel produced a significant decrease of the maximal basal pressure in subjects with hemorrhoids, as well as a lessening of pain in 37% of patients with anal fissure and in 55% of those with hemorrhoids. This symptomatic improvement was not correlated with changes in pressure. Therefore we conclude that the hypertonicity of the anal canal is not secondary to pain and must be evaluated as a disturbance related to the subjacent lesion.
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PMID:[Pressure of the anal canal in patients with hemorrhoids or with anal fissure. Effect of the topical application of an anesthetic gel]. 156 1

Patients on chronic hemodialysis for end-stage renal disease (ESRD) may develop anorectal problems necessitating surgery. From January 1984 to December 1987, 18 ESRD patients underwent anorectal surgery. During this period, a mean of 215 patients underwent dialysis. Patients with ESRD present with characteristic problems: chronic constipation, need for dialysis pre- and postoperatively with heparin infusion, anemia, anticoagulation secondary to the consequences of uremia, and significant medical problems including coronary artery disease, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease (COPD). Two patients had concomitant anal fissure, two had fistula-in-ano, and one had an acute perianal abscess. In two patients, the postoperative course was complicated by hemorrhage and, in one patient, by abscess formation. There was no delay in wound healing compared with a cohort group. The essentials of perioperative management are discussed with respect to timing of dialysis, methods of anesthesia and pain management, coagulation screening, and complications. Patients on well-managed chronic dialysis will tolerate anorectal surgery without undue jeopardy.
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PMID:Is anorectal surgery on chronic dialysis patients risky? 173 84

The diagnosis of an anal fissure can be made definitively on the basis of history and inspection. Therapy aims to stop the vicious circle of increased resting pressure, decreased perfusion, pain and obstipation. Chronic fissures are complicated by an incomplete fistula-in-ano. It is treated by laying open the fistula and sphincterotomy.
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PMID:[Diagnosis and principles of treatment for fissure in ano]. 257 40

In January 1986 we initiated a prospective study in our center to evaluate the results of surgery in patients with anal fissure. Three groups were considered according to type of surgery: internal lateral sphincterotomy (ELI), lateral sphincterotomy and resection of cutaneous fibroma (ELI + FC), and sphincterotomy with hemorrhoidectomy (E + H). The basic objective was to evaluate postoperative pain, days of hospitalization and out-patient follow-up, complications and number of recurrences. Postoperative pain occurred in 12% of internal lateral sphincterotomies, in 42% of lateral sphincterotomies with resection of cutaneous fibroma in 50% of sphincterotomies with hemorrhoidectomy, as measured by the number of patients who requested analgesics. The hospital stay was similar in the first two groups (96 and 90% less than 24 hours) and longer in the third (50% greater than 24 hours). Out-patient follow-up was limited to one visit in 90% of internal lateral sphincterotomies, while 85% of internal lateral sphincterotomies + fibroma resection required more than two visits and 100% of sphincterotomies with hemorrhoidectomy needed three or more. Nine percent of those operated had mild complications like low fever, ecchymoses, fistula or wound infection. No patient presented incontinence or recurrence of the fissure. We conclude that internal lateral sphincterotomy is an ideal procedure for the treatment of anal fissure and, if possible, additional surgery should be avoided, however insignificant it may appear.
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PMID:[Internal lateral sphincterectomy. Results]. 276 41

The incidence of proctological diseases is on a rising trend, and some of them require surgical treatment. Outpatient handling is indicated, following thorough diagnosis, and in common practice worldwide. The surgical specialist, in command of pain-killing methods, is in a position to apply surgical treatment on a outpatient basis. Careful attention has to be given, in this context, to the anal complex and anal sanitation. Perianal thrombosis, incarcerated prolapsed haemorrhoids, acute anal fissure, and, with some reservation, periproctic abscess are situations in which acute action is recommended, while elective interventions seem to be indicated for chronic anal fissure, cryptitis, few anal fistulae, and perianal changes of the skin, but with limitations on the haemorrhoidal problem.
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PMID:[Surgery of proctologic diseases in the polyclinic]. 340 50

Chronic anal fissure is an extremely common problem of the anorectum. It is often confused with symptomatic hemorrhoids and is frequently missed by the examining physician. Symptoms are most commonly pain and bleeding after defecation. A simple office procedure involving partial lateral internal sphincterotomy with or without excision of a sentinel tag has been used over the past five years with extremely satisfactory results. This procedure was used upon 86 patients. Anatomic and symptomatic relief was obtained in 96.4 per cent of the patients. Due to diagnostic related groups and attempts at cutting medical costs by avoiding hospitalization, sphincterotomy performed as an office procedure is the method of choice for treating chronic anal fissures unresponsive to medical management. Hospitalization is rarely required.
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PMID:Simple in-office sphincterotomy with partial fissurectomy for chronic anal fissure. 358 25

High sphincter pressures recorded in patients with fissure-in-ano have been attributed to sphincter spasm induced by wide recording assemblies. To investigate this hypothesis, anal sphincter pressure was measured using a series of perfused probes of 0.4-2 cm diameter in six men with chronic anal fissure in whom digital examination was easily tolerated. The results were compared with those from 14 normal men. The resting pressure within the anal canal exceeded the normal range in all six patients irrespective of probe size. With the smallest (0.4 cm) probe, the resting pressure was 114 +/- 17.1 cmH2O (mean +/- s.d.) in patients with fissure and 73.1 +/- 27.0 cmH2O (mean +/- s.d.) in control subjects (P less than 0.001) even 10 min after introduction of the device. The minimum residual pressure attained during inflation of a rectal balloon with 100 ml of air was higher in patients with anal fissure than controls, reaching statistical significance with the 1.0 cm probe (80.8 +/- 17.7 cmH2O versus 36.9 +/- 19.0 cmH2O, P less than 0.001). Maximum pressures recorded during a voluntary contraction of the sphincter were no higher than in control subjects. The results suggest that high resting pressures are recorded in patients with chronic anal fissures even when small probes are employed and are unlikely to be due to spasm, but probably represent a true increase in basal sphincter tone. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal.
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PMID:Anal hypertonia in fissures: cause or effect? 371 68

In 26 volunteers without anorectal complaints, and in 31 patients with anorectal problems such as hemorrhoidal disease, anal fissure, and proctalgia fugax, baseline resting anal canal pressures were recorded manometrically for 5 minutes at room temperature (23 degrees C). In 16 volunteers (Group A) and 21 patients (Group B) anorectal manometry was then performed while the anus was immersed in water at varying temperatures (5 degrees C, 23 degrees C, and 40 degrees C). In ten volunteers (Group A') and ten patients (Group B') resting pressures were recorded for an additional 30 minutes following immersion for 5 minutes at 40 degrees C. In all subjects (at least P less than 0.01), resting anal canal pressures diminished significantly from baseline after immersion at 40 degrees C, but remained unchanged in all subjects after immersion at 5 degrees C and 23 degrees C. In Group A', anal canal pressures remained significantly reduced for 15 minutes (P less than 0.02). In Group B', significant reduction in resting pressure lasted 30 minutes (P less than 0.02). Wet heat applied to the anal sphincter apparatus significantly and reproducibly decreased resting anal canal pressures over time, and therefore was likely to benefit patients after anorectal operations and those with anorectal pain.
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PMID:Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles. 394 15


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