Anorectal Physiologic Testing in Anal Fissure Disease

The assessment of anorectal physiologic abnormalities that occur in anal fissure disease has been ongoing for over 30 years. The goals have been to define what occurs, correlate it with symptoms, and measure the changes that follow therapeutic intervention. During this period, the technology available for such investigations has become more sophisticated and standardized. The fundamental phenomenon observed have been that of increased anal pressures in patients with fissures compared with control subjects and a significant and lasting fall in such pressures with therapeutic intervention, correlating with symptom relief and fissure healing. Other physiologic phenomenon have also been associated with fissures, such as pressure “over-shoot” with rectal distention and the increased presence of ultra-slow waves in fissure patients compared with normal controls. The existing literature has been reviewed, and will be summarized herein, with the intent to integrate it into a sensible presentation of the physiologic abnormalities seen with anal fissure patients.