Efficacy of Combined Local Infiltration Anaesthesia and Controlled Anal Dilatation Followed by Conservative Therapy Versus Conservative Therapy Alone in Acute Primary Anal Fissure - A Preliminary Report

Introduction: Anal fissure is a painful anorectal disorder characterized by sphincter spasm and impaired healing due to elevated internal sphincter tone. Conservative management remains the mainstay, but persistent symptoms often progress to chronicity requiring surgical intervention. Methods: A prospective study was conducted over 18 months at Nil Ratan Sircar Medical College, Kolkata, involving 40 patients with acute midline anal fissure. Participants were randomized into two equal groups. The test group received local infiltration anaesthesia with 1% lignocaine at four quadrants followed by two-finger controlled anal dilatation (CAD) to a 40 mm anal opening, in addition to standard conservative therapy. The control group received conservative management alone. Outcomes were evaluated at 1, 2, 3, and 6 weeks using the Visual Analogue Scale (VAS) for pain, bleeding, sphincter tone, and associated symptoms. Results: Baseline parameters were comparable between groups. The test group showed significantly earlier pain relief (p < 0.01), faster cessation of bleeding (p ≈ 0.02), and normalization of sphincter tone (p < 0.001) compared with controls. Improvement in discharge and pruritus was observed but was not statistically significant. No complications, including incontinence, were reported. Conclusion: Local anaesthetic-assisted CAD, when combined with conservative therapy, offers superior short-term symptomatic relief and accelerates healing in acute anal fissure without compromising continence. Despite limitations of small sample size and short follow-up, this simple office-based intervention appears to be a safe and effective adjunct to standard care, potentially reducing chronicity and need for surgery.