For more than a century, surgery has been the treatment of choice for the management
of chronic anal fissure and lateral internal sphincterotomy is the recommended
procedure [9]. However, faecal soilage is a major concern and the rate of faecal
incontinence has been reported to be as high as 30% [10]. This has prompted the
development of chemical sphincterotomy such as topical nitroglycerin, calcium
channel blocker, or botulinum toxin [11]. These noninvasive medical therapies have
shown promising results and have largely replaced surgery as the first line treatment
for chronic anal fissure [3]. But the initial success of these pharmacological agentsas their side effects [3]. A noninvasive, non-pharmacological novel concept based on
the stretching of the posterior anal area and the anal verge as outlined above and
demonstrating the effectiveness of a posterior perineal support in facilitating the
healing of chronic anal fissure is being published [4]. Colorec (Trademark) (Fig 2) is
a specially designed toilet seat device with a posterior anal support. It holds up the
anococcygeal region just behind the posterior anus. This will help to prevent
overstretching of the anus especially at the posterior area by exerting a counter
pressure as the faeces traverse the anal canal (Fig 3). This study was designed to test
the hypothesis that the combination of 0.2% topical nitroglycerin and a specially
designed toilet seat that provided a posterior perineal support is superior to that of
topical nitroglycerin alone in the healing of chronic anal fissure.
have not led to their widespread use due to concerns regarding their efficacy as well as their side effects [3]. A noninvasive, non-pharmacological novel concept based on
the stretching of the posterior anal area and the anal verge as outlined above and
demonstrating the effectiveness of a posterior perineal support in facilitating the
healing of chronic anal fissure is being published [4]. Colorec (Trademark) (Fig 2) is
a specially designed toilet seat device with a posterior anal support. It holds up the
anococcygeal region just behind the posterior anus. This will help to prevent
overstretching of the anus especially at the posterior area by exerting a counter
pressure as the faeces traverse the anal canal (Fig 3). This study was designed to test
the hypothesis that the combination of 0.2% topical nitroglycerin and a specially
designed toilet seat that provided a posterior perineal support is superior to that of
topical nitroglycerin alone in the healing of chronic anal fissure.