New therapeutic perspectives in the treatment of anal fissure




Anal Fissure; Aloe; Clinical Treatment; Vitamin A; Coloproctology.


This is a systematic review of the literature in order to present scientific evidence about the best therapy for anal fissure. Retrospective and analytical study carried out from 1989 to 2020, in the Bireme, Pubmed and Scielo databases. The association of the descriptors “anal fissure” was used; "Aloe"; “Clinical treatment”; "vitamin A"; “Coloproctology”. Of the 238 articles analyzed, 38 were included in the review for meeting the inclusion criteria. Among the results, it was shown that conventional treatments, despite being effective (the gold standard being internal lateral sphincterectomy), have relevant side effects, thus, it is concluded that further research will be necessary to prove the effectiveness of new treatment options.


Alexander J., Auounsson G., Benford D., Cockburn A., Cravedi J., Dogliotti E., Domenico A., Férnandez-Cruz M., Fürst P. & Fink-Gremmels J. (2008). Cross-contamination of non-target feedingstuffs by monensin authorised for use as a feed additive. EFSA J., 592, 1–40.

Andrade F. S. S. D., Clark R. M. O. & Ferreira M. L. (2014). Efeitos da laserterapia de baixa potência na cicatrização de feridas cutâneas. Revista Colégio Brasileiro de Cirurgia. 41(02).

Bleday R. (2020). Anal fissure: Medical management. UpToDate.: 20anal:%20gest %C3%A3o%20m%C3%A9dica&source=search_result&selectedTitle=10~150&usage_type=default&display_rank=10

Bourguignon F. A. M., Feitosa A. C. F., Beltrão G. C. & Pagnoncelli G. C. (2006). Utilização do laser de baixa intensidade no processo de cicatrização tecidual. Revista Portuguesa de Cirururgia Maxilofacial. 46(1), 37-43.

Bove A., Balzano A., Perrotti P., Antropoli C., Lombardi G. & Pucciani F. (2004). Different anal pressure profiles in patients with anal fissure. Tech Coloproctol. 8 (3), 151-6. doi: 10.1007/s10151-004-0079-z

Channual J., Choi B., Osann K., Pattanachinda D., Lotfi J. & Kelly K. M. (2008). Vascular effects of photodynamic and pulsed dye laser therapy protocols. Lasers Surg Med. 40(9), 644-50. doi: 10.1002/lsm.20673

Chen R., Zhang J., Hu Y., Wang S., Chen M. & Wang Y. (2014). Potential antineoplastic effects of aloe-emodin: A comprehensive review. The American Journal of Chinese Medicine. 42(02):275–88.

Chini L. T., Mendes R. A., Siqueira L .R., Silva S .P., Silva P. C. S., Dázio E. M. R. & Fava S. M. C. L. (2017). O uso do Aloe sp (babosa) em feridas agudas e crônicas: revisão integrativa. Aquichan. 17(1), 7-17. Doi: 10.5294/aqui.2017.17.1.2

Choi S. W., Son B. W., Son Y. S., Park Y. I., Lee S. K. & Chung M. H. (2001). The wound-healing effect of a glycoprotein fraction isolated from aloe vera. British Journal of Dermatology. 145(4), 535-45. doi: 10.1046/j.1365-2133.2001.04410.x

Collins E. E. & Lund J. N. (2007). A review of chronic anal fissure management. Techniques In Coloproctology. 11(3), 209-223.

David B. S. (2020). Anal fissure: Clinical manifestations, diagnosis, prevention. UpToDate. Disponível em: prevention?search=Fissura%20anal:%20manifesta%C3%A7%C3%B5es%20cl%C3%ADnicas,%20diagn% C3%B3stico,%20preven%C3%A7%C3%A3o&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

De Nardi A., Rodaski S., Sousa R., Baudi D. & Castro J.(2004) Cicatrizaçao secundária em feridas dermoepidérmicas tratadas com ácidos graxos essenciais, vitaminas A e E, Lecitina de soja e iodo polivinilpirrolidona em cães. Archives of Veterinary Science. 9(01).

Esfahani M. N., Madani G. & Madhkhan S. (2015). A novel method of anal fissure laser surgery: a pilot study / Lasers in medical science. 30(6), 7. doi: 10.1007/s10103-015-1771-0

Freitas V. S., Rodrigues R. A. F. & Gaspi F. O. G. (2014). Propriedades farmacológicas da aloe vera. Revista Brasileira de Plantas Medicinais. 16(2), 299-307.

Giordano P., Gravante G., Grondona P., Ruggiero B., Porrett T. & Lunniss P. J. (2009). Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg. 33, 1058–1063. doi: 10.1007/s00268-009-9937-1

Garcez A. S., Ribeiro M. S. & Nunez S. (2012). Laserterapia de baixa Potência: princípios básicos e aplicações clínicas em odontologia. São Paulo.

Garrido R. M. D., Lagos N. P .D., Lattes K. M. D., Abedrapo M. M. D., Bocic G. M. D., Cuneo A. M. D., Chiong H. M. D., Jensen C. M. D., Azolas R. M. D., Henriquez A. T. M. & Garcia C. M .S. (2005). Gonyautoxin: New Treatment for Healing Acute and Chronic Anal Fissures. Santiago. Diseases of the Colon & Rectum. 8(2):335-40. doi: 10.1007/s10350-004-0893-4

Gupta P. (2006). Randomized, controlled study comparing sitz-bath and no-sitz-bath treatments in patients with acute anal fissures. ANZ J Surg. 76(7), 718–721. doi: 10.1111/j.1445-2197.2006.03838.x.

Habr-Gama A., Sobrado C. W., Araujo S. E. A., Nahas S. C., Birbojm I., Nahas C. S .R. & Kiss D. R. (2005). Surgical treatment of anal stenosis: assessment of 77 anoplasties. Clinics (Sao Paulo). 60(1), 17-20. doi: 10.1590/s1807-59322005000100005

Jones O. M., Brading A. F. & Mortensen N. J. (2002) Phosphodiesterase Inhibitors Cause Relaxation of the Internal Anal Sphincter In Vitro. Dis Colon Rectum, 45, 530–536.

Khanna A., Shankar L. R., Keelan M. H., Kornowski R., Leon M., Moses J. & Kipshidze N. (1999). Augmentation of the expression of proangiogenic genes in cardiomyocytes with low dose laser irradiation in vitro. Cardiovascular Radiation Medicine, 1(3), 265-269. doi: 10.1016/s1522-1865(99)00018-9

Klosterhalfen B., Vogel P., Rixen H. & Mittermayer C. (1989). Topography of the inferior rectal artery. Diseases Of The Colon & Rectum, 32(1), 43-52.

Malafaia O., Campos A. C .L., Torres O. & Goldenberg S (2006). Os fitoterápicos e seu potencial na cicatrização em cirurgia. Ata Cirúrgica Brasileira, 21(3).

Moghimi M. & Ghodosi I. (2006). Topical Sildenafil (Viagra®) in the Treatment of Chronic Anal Fissure: A Randomized Double Blind Controlled Trial. International Journal of Pharmacology, 2, 608-612.doi:10.3923/ijp.2006.608.612

Moreira H., Moreira J. P. T., Moreira J. H., Lousa L. R. & Oliveira E. C. (2003). Tratamento clínica conservador e cirúrgico da fissura anal. Revista brassileira Coloproctologia, 2003;23(2):89-99. Disponível em:

Patti R., Guercio G., Territo V., Aiello P., Angelo G. L. & Vita G. (2012) Advancement flap in the management of chronic anal fissure: a prospective study. Updates in Surgery 64(2), 101-106. doi: 10.1007/s13304-012-0147-2

Pereira A. S., Shitsuka D. M., Parreira F. J. & Shitsuka R. (2018). Metodologia da pesquisa científica. Santa Maria/RS. Ed. UAB/NTE/UFSM.

Rahmani N., Khademloo M., Vosoughi K. & Assadpour S. (2014). Effects of aloe vera cream on chronic anal fissure pain, wound healing and hemorrhaging upon defection: a prospective double blind clinical trial. Eur Rev Med Pharmacol Sci, 18(7), 1078-84.

Ramos A. P. & Pimentel L. C. (2011). Ação da babosa no reparo tecidual e cicatrização. Brazilian Journal of Healt, 2.ção-da-Babosa-no-reparo-tecidual-e-cicatrização-%2F-Ramos-Pimentel/6ad0e16bc54b6ca7 9261b04bda6b7f5fc7 155e2d

Richard C. S., Gregoire R., Plewes E.A., Silverman R., Burul C., Buie D., Reznick R., Ross T., Burnstein M., O’Connor B.L., Mukraj D. & McLeod R.S. (2000). Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group. Dis Colon Rectum, 43, 1048–1057. doi: 10.1007/BF02236548

Rourke W. A., Murphy C. J., Pitcher G., Van R. J. M., Burns B. G., Thomas K. M. & Quilliam M. A. (2008). Rapid postcolumn methodology for determination of paralytic shellfish toxins in shellfish tissue. J. AOAC Int, 91, 589–597. Disponível em:

Roztocil K. & Prerovsky I. (1989) The effect of 7-monohydroxyethylrutoside on capillary filtration rate in the lower limb of man. John Libbey, 719-21. Disponível em:

Sahebally S. M., Walsh S. R., Mahmood W., Aherne T. M. & Joyce M. R. (2018). Anal advancement flap versus lateral internal sphincterotomy for chronic anal fissure- a systematic review and meta-analysis. Int J Surg, 49, 16-21. doi: 10.1016/j.ijsu.2017.12.002

Schouten W. R., Briel J .W., Auwerda J. J. & Boerma M. O. (1996). Anal fissure: new concepts in pathogenesis and treatment. Scand J Gastroenterol, 218, 78-81. doi: 10.3109/00365529609094734

Schouten W. R., Briel J. W. & Auwerda J. J . A. (1994). Relationship between anal pressure and anodermal blood flow. Diseases Of The Colon & Rectum, 37(7), 664-669. doi:10.1007/bf02054409

Wadworth A. N. & Faulds D. (1992). Hydroxyethylrutosides. A review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders. Drugs, 44(6),1013-1032. doi: 10.2165/00003495-199244060-00009. PMID: 1282862.

Yakoot M. & Abdel S M (2009). Study of efficacy and safety of a new local cream ('healer') in the treatment of chronic anal fissure: a prospective, randomized, single-blind, comparative study. Arq Gastroenterol, 46(3), 179-82. doi: 10.1590/s0004-28032009000300007

Zinder R., Cooley R., Vlad L.G. & Molnar J. A. (2019). Vitamin A and Wound Healing. Nutrition in clinical practice: official publication of the American Society for Parenteral and Enteral Nutrition, 34(6), 839–849.



How to Cite

SANTOS, T. F. dos; RODRIGUES, B. I. de P. O.; LEITE, T. M.; VASCONCELOS, L. G. de A.; SANTOS, C. H. M. dos; DOURADO, D. M. New therapeutic perspectives in the treatment of anal fissure. Research, Society and Development, [S. l.], v. 10, n. 10, p. e245101018793, 2021. DOI: 10.33448/rsd-v10i10.18793. Disponível em: Acesso em: 22 apr. 2024.



Review Article