Long-Term Outcomes after Anal Dilatation for Anal Fissure

Background: Recurrence and anal incontinence are recognized as troublesome complications following the treatment of fissure in ano by anal dilatation. Most previous studies of anal dilatation have evaluated outcomes, only, over the short term. Patients and Methods: Attempts were made to contact 104 patients who had been treated by anal dilatation for fissure in ano during the period 1975–1990. Each patient contacted was sent a postal questionnaire. Each patient was assigned an incontinence score based on the information returned and this score was compared with the scores of five age and sex matched controls. Patients requesting reevaluation of their incontinence in their questionnaires were further examined by endoanal ultrasound and anorectal manometry. Results: 45 patients responded, 14 had died, and 45 were lost to follow up. The median follow-up interval was 15.5 years. The total self reported recurrence rate was 24%. Patient's incontinence scores were low and did not differ significantly from matched population controls. Conclusions: Fissure in ano treated by anal dilatation has a significant recurrence rate. The incidence and severity of anal incontinence in those treated by anal dilatation is no different to that of the general population. Other treatment modalities should be evaluated over the longer term before anal dilatation is discarded as a treatment option for fissure in ano.