A. Bove () • A. Balzano • P. Perrotti • C. Antropoli • G. Lombardi Coloptroctology Unit Department of Gastroenterology Cardarelli Hospital Via Cardarelli 9, I-80131 Naples, Italy E-mail: boveantonio@jumpy.it F. Pucciani Coloproctology Unit Department of Surgery Careggi Hospital Florence, Italy 57.1% of those in group C. Four elderly patients (7%) of group A had a hypotonic anal canal. No differences were found regarding maximal voluntary contraction, recto-anal inhibitory reflex, rectal sensations and rectum compliance between patients and controls. Conclusions Patients with chronic anal fissures may have several anal pressure pro- files. The anal canal is often normotonic. Fissures with hypertonic or normo-hypotonic anal canal need different therapies. Key words Fissure in ano • Manometric findings Introduction Anal fissure is a tear of the skin-lined part of the anal canal. Nearly all chronic fissures occur in the posterior midline of the anal canal [1], a few (10%) are in the ante- rior midline [2, 3], and they are rarely located in the later- al anal walls [4]. A consistent debate exists about the association between anal fissures and hypertonic anal canal. Several studies reported an association between high resting pres- sures in the anal canal and anal fissures of the posterior midline [5, 6]. This concern supported the lateral internal sphincterotomy as the gold standard surgical technique for chronic fissures [7]. Nevertheless, patients with anal fis- sure and normal pressures of the anal canal may exist [8] and sphincterotomy, if performed in these patients, could induce hypotonia [9]. Anterior and lateral fissures are not associated with hypertonia; when they are observed, one should search for underlying diseases [4]. To better understand the pathophysiology of anal fis- sures, we designed a study to evaluate the relationship between anorectal manometric findings and the topogra- phy of anal fissures. A. Bove • A. Balzano • P. Perrotti • C. Antropoli • G. Lombardi • F. Pucciani Different anal pressure profiles in patients with anal fissure Received: 30 December 2002 / Accepted: 10 May 2004 ORIGINAL ARTICLE Abstract Background A consistent debate exists about the association between anal fissure and hypertonic anal canal. The aim of this study was to determine if the mano- metric findings in patients with chronic anal fissures var- ied according to the topography of the fissure. Patients and methods Seventy-three outpatients (52 men, 71%) with chronic anal fissures and nine healthy volunteers (5 men, 55%) were examined. Patients were classified according to the topography of the anal fissures: posterior midline (group A), anterior midline (group B), and lateral position (group C). We use computerized anorectal manometry to evaluate anal resting pressure, maximal voluntary contraction, recto-anal inhibitory reflex, rectal sensations and rectum compliance. Results In Group A, the mean pressure was higher than that of controls (p<0.05), and the resting pressure 2 cm from anal verge was higher than that of other groups and controls (p<0.05). Normotonic anal canal was found in 49.1% of patients in group A, in 66% of those in group B and in Tech Coloproctol (2004) 8:151–157 DOI 10.1007/s10151-004-0079-z