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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

While these large-scale observational studies are encouraging, more research is needed, including randomized controlled trials to determine whether GLP-1 medications directly reduce substance use, including stimulant use, and improve long-term recovery outcomes

Seth RK, Das S, Dattaroy D, Chandrashekaran V, Alhasson F, Michelotti G, Nagarkatti M, Nagarkatti P et al (2017) TRPV4 activation of endothelial nitric oxide synthase resists nonalcoholic fatty liver disease by blocking CYP2E1-mediated redox toxicity

The mechanism of such repigmentation remains unclear

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