That small, painful wound...

Today we are talking about fissures.
And not because anal fissure is a little-covered topic or unknown to most, no really: you will find thousands of pages to read in Dr. Google's big bag-and among them some of ours on the dedicated page of our website, including our patient brochure.
So we are not going to tell you that anal fissure is a tear in the anoderm, nor that it is closely related (among other things) to constipation and pregnancy, or that it is extremely painful at defecation and for hours afterwards, and among the main causes of the "blood stains" that can be seen on toilet paper.
We are not going to tell you anything about the "pathophysiology" of anal fissure (the injury that causes spasm of the anal sphincter, which results in decreased blood flow to the injured area, which slows or stops healing altogether, keeping the vicious cycle active in a kind of mythological Uroboros...) - no; nor are we going to talk about the psychological aspects of this pathology, which even patients know very well (the pain is so much and such that one is afraid to go to the bathroom, which aggravates constipation and makes subsequent defecation extremely more painful).
Rather, we want to protest the barbaric methods of treatment adopted by many proctologists in Italy.
Serial anal dilations are a medieval procedure, painful, barbaric, often ineffective, and poorly accepted by many patients. Why should one agree to let something "in" when the pain at the "outflow" of something else from the same place is excruciating? Really, we can never understand it.
The solution to anal fissure is to cause, pharmacologically or surgically, a relaxation of the internal sphincter of the anus: in the former case we speak of "chemical sphincterotomy," in the latter of "sphincterotomy" tout court.
If the sphincter relaxes, it resumes blood flow to the anal fissure area, which heals: simple, right? And why induce sphincter relaxation by (painful) dilation if there are topical medications that can accomplish this? And again: why insist on local therapy of an anal fissure that does not heal, if with surgery--simple and perfectly tolerated when performed by skilled hands--the pain disappears in a matter of hours?
Many proctologists, in Italy, say the surgery is risky and can cause incontinence. True! you can have incontinence related to gas, which of disappears quickly and without leaving relics; the rates of fecal incontinence are negligible: and all this in front of the patient who, the day after surgery says, "What miracle is this? I have no more pain!"
The surgery also cures the psychological aspects of the pathology: these are people who dream about the fissure - with terror - at night; and we, with a surgical procedure that takes less than half an hour, can free them from these nightmares.
Think about it before you buy dilators; ask for a second opinion, you will not be disappointed!