April 2026, Volume 4, Issue 4

Author

M. Sadhana, M. Vimalnathan and B. Sridhar

Abstract

Background: Chronic anal fissure is a common and painful anorectal condition that may become resistant to conventional medical treatment in a significant proportion of patients. Chronic resistant anal fissure poses a therapeutic challenge, and early diagnosis and timely escalation of therapy remain essential to improve patient outcomes. Objectives: To describe the clinical profile of chronic anal fissure in patients attending a tertiary care center and to analyze its association with age, sex, mode of disease onset, clinical symptoms, and outcomes over a six-month follow-up period. Methods: This prospective observational study was conducted on 30 patients with chronic anal fissure admitted to the Department of General Surgery, GMKMCH, Salem, between July 2022 and June 2024. Patients with typical chronic anal fissure were included, while pregnant women, patients with pacemakers, and those on anticoagulant therapy were excluded. Data on demographic characteristics, socioeconomic status, clinical presentation, duration of symptoms, and disease onset were collected using a structured proforma. Results: The proportion of chronic resistant anal fissure was 36.7%. Most patients were aged 40 years or above, with a slight male predominance. Pain was the predominant symptom, often associated with bleeding and itching. Chronic resistance was significantly associated with age ?40 years (p = 0.05) and symptom duration of one year or more (p = 0.05). No significant association was found with sex, socioeconomic status, or mode of disease onset. At six months, only 30.0% of patients showed complete improvement, while the remainder had partial or no improvement. Conclusion: Chronic resistant anal fissure was observed in more than one-third of patients, particularly among older individuals and those with longer symptom duration. These findings underscore the need for early diagnosis and timely escalation of treatment in high-risk groups.