الفهرس 
Review of literature
Anatomy of the Rectum and Anal CanalOnly 14 pages are availabe for public view
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Abstract
The aim of this work is to know the pathogenesis of constipation in patients with anal fissure. Anorectal manometry and EMG study was done to 3 groups: A: 15 control, B: 1 5patients with chronic anal fissure, C: 15 patients with acute anal fissure. Filow up of both groups of patients 3 months later on after treatment.
Constipation is a symptom rather than a disease and represents a subjective interpretation of a real or imagined disturbance of bowel function. Although constipation often is defined as a frequency of defecation of twice weekly or less, frequency alone is not a sufficrent criterion. Most individuals who describe themselves as constipated complain of excessive straining or discomfort at defecation or the passage of hard stools, although frequency of defecation is with in normal range.
Pathophysiology of anal fissure: the passage of a hard, dry stool cause tearing of anal skin . the capillary system of the inferior rectal artery ended at the posterior commissure, the blood supply to the posterior anoderm is lower than at other sides, making this site prone to ischemic injury. Spasm of the internal anal sphincter may worsen the ischaemia and retard healing. Anal manometric studies show an increase in the resting anal pressure. Additional risk factors include a low fiber diet and previous anal surgery.
The anorectal band shares in the genesis of constipation and anal fissure. The fibrous band and associated rectal neck stenosis elevate the rectal neck pressure and hinder full neck expansion at defecation with a resulting partial obstruction to the descending fecal mass. Extrastraining straining is necessary to effect rectal neck dilatation sufficient for evacuation.
The treatment of anal fissure includes dietary manipulation medication, anal dilation , fissurectomy, bandotomy and internal sphincterotomy.
Patients with anal fissure are told to consume high fibre foods. Topical anaesthetics, corticosteroids, stool softeners and warm baths may help relieve pain. This conservative therapy heal acute anal fissure within 3 weeks in almost 90% of patients with acute anal fissure, only 40% to 60% of patients with chronic anal fissure improve with conservative therapy.