Sacral Nerve Stimulation For Treatment of Anal Fissure
Anal fissure is a crack in the epithelium of the anus that causes anal pain and bleeding during or after defecation. The pathogenesis is not well understood and healthy people of all age can be affected.
The most common treatment of chronic anal fissure is surgical intervention. It has reached cure to more than 90%, but it has led to fecal incontinence to 17%-30% of the patients. Drugs have been also used for the treatment in attempt to reduce the sphincter pressure. However, they are not very satisfactory, showing transient action or side effects like headache.
Yakovlev and Karasev (2010) report a case of a woman 20 years old. She was diagnosed with chronic anal fissure and had already used pharmacological treatments which she suffers with headache, incontinence of flatus and the recurrence of the disease. The patient underwent placement of wire leads in the sacrum between S1 and S4 and received stimulation for two weeks 24 hours a day. She reported having no more pain in the 10th day and she got healed of the anal fissure after these two weeks under electrical stimulation. There was not any related complication and the disease did not come back during the 20 months of follow-up.
Thus sacral nerve stimulation (SNS) is a rapid and effective option to treat anal fissures without complications. Also the therapy can be adjusted according to the patient and is completely reversible. In the literature the major complications related to SNS are discomfort and infection (that can afflicted 3% - 17% of patients that underwent SNS).
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