Anal fissures are believed to result from laceration by a hard or large stool or from frequent loose bowel movements Caused by: hard stool passage (constipation), hyperactive sphincter, disease process (e.g., Crohns disease) The fissure may cause internal sphincter spasm, decreasing blood supply and perpetuating the fissure Presents with pain in the anus, painful (can be excruciating) bowel movement , rectal bleeding , blood on toilet tissue after bowel movement, sentinel tag, tear in the anal skin, extremely painful rectal exam, sentinel pile, hypertrophic papilla Diagnosis is made by history and visual inspection +/- anoscopy Alternatively, reproducing the patient's presenting complaints (ie, anal pain) by gentle digital palpation of the posterior (or anterior) midline anal verge is diagnostic A sentinel pile (thickened mucosa) is found below the fissure Unless findings suggest a specific cause or the appearance and/or location is unusual, further studies are not required For patients with a typical anal fissure (ie, a single posterior or anterior fissure with no evidence of Crohn's disease ), treatment consists of a combination of supportive measures (fiber, sitz bath, topical analgesic) and one of the topical vasodilators (nifedipine or nitroglycerin) for one month
Its reductive half-reaction with GSH has a rate constant of 1.2 10 5 M 1 s 1 , which is ten times slower than the oxidative half-reaction with GSSCys
PMID 17457338
Its immune-modulating properties have attracted considerable interest among clinicians seeking supportive therapies for individuals with recurrent infections or impaired immune function
It can also be mental/emotional, as well as physical
Notable findings include: A substantial review involving 80 male participants identified nausea (41%) and stretching/yawning (56%) as the most common side effects
