From the Guidelines
The treatment for anal sphincter dysfunction should prioritize the use of dietary and lifestyle changes, medical therapy, and minimally invasive procedures to achieve internal anal sphincter (IAS) relaxation, reduce pain, and facilitate healing. The primary goals of treatment are to minimize anal trauma, increase blood flow, and treat pain. To achieve these results, the cornerstones of treatment include:
- Stool softeners (increased intake of oral fluids, high-fiber diet or fiber supplements, and bulk forming laxatives)
- Sphincter muscle relaxers (warm sitz baths, local application of calcium channel blockers like Diltiazem or Nifedipine, local application of Nitrates like Nitroglycerin and Botulinum injection that determines a temporal paralysis of the anal sphincter muscle for 2–3 months) 1. According to a recent systematic review and meta-analysis, calcium channel blockers (CCB) such as diltiazem or nifedipine are more effective than glyceryl trinitrate and have less risk of headache and hypotension 1. The topical use of CCBs is suggested due to the possibility of systemic side-effects and similar rates of healing and pain relief 1. Pain control is also an essential aspect of treatment, and various options are available. There is no standard duration of therapy, but administration for at least 6 weeks is suggested, with pain relief usually occurring after 14 days 1. Minimally invasive procedures like balloon dilatation and staged dilatation have shown healing rates similar to those obtained after internal sphincterotomy, with complication and incontinence rates near zero 1. However, these results are mainly focused on chronic anal fissures, and more research is needed to make recommendations in the acute setting. In general, treatment should be individualized based on the severity of symptoms, patient characteristics, and the presence of any underlying conditions. The use of manual dilatation is no longer recommended due to the high risk of incontinence and the superiority of internal sphincterotomy 1. Lifestyle modifications, including a high-fiber diet, regular exercise, and stress management techniques, are essential adjuncts to medical therapy. Overall, a comprehensive treatment approach that incorporates dietary and lifestyle changes, medical therapy, and minimally invasive procedures can help achieve the best possible outcomes for patients with anal sphincter dysfunction.
From the Research
Treatment for Anal Sphincter Dysfunction
There are no research papers provided that directly address the treatment for anal sphincter dysfunction. The studies provided focus on the treatment of sphincter of Oddi dysfunction, which is a different condition.
Sphincter of Oddi Dysfunction Treatment
- Endoscopic sphincterotomy (EST) is a recommended treatment for sphincter of Oddi dysfunction, particularly for patients who are refractory to conservative treatment 2, 3.
- EST has been shown to be effective in relieving symptoms in patients with sphincter of Oddi dysfunction, with success rates ranging from 66% to 91.7% 2, 3, 4.
- Transduodenal sphincteroplasty is a surgical treatment option for select patients with sphincter of Oddi dysfunction, and has been shown to provide durable symptom management 4.
- The effectiveness of endoscopic sphincterotomy compared to sham or other treatments is uncertain, with very low-certainty evidence available 5.
- Non-invasive diagnostic methods, such as secretin-stimulated magnetic resonance cholangiopancreatography and morphine-provocated hepatobiliary scintigraphy, may be useful in diagnosing sphincter of Oddi dysfunction, but have limited sensitivity and specificity 6.