ABSTRACT
Anorectal complaints are common, but often poorly understood. More often than not, a referral for “hemorrhoids” is often vague and can refer to any number of perianal abnormalities. Proper treatment depends on the correct diagnosis. Once an accurate assessment is made, therapy can be based on evidence-based guidelines for the treatment of anorectal abscesses, fistula, and fissures. This chapter covers anal abscess, anal fissure, and fistula-in-ano. Multiple randomized prospective trials have examined the role of various nonoperative therapies in the treatment of anal fissures. All effective modalities are aimed at decreasing the hypertonicity found in the internal anal sphincter of fissure patients. Therapies that do not lower sphincter pressures have been uniformly found to be no better than placebo. Most studies focus on chronic fissures. Nonsurgical therapies are superior to placebo but inferior to lateral internal sphincterotomy for healing anal fissures.
