Anal manometry
Studies have shown that patients with anal fissure demonstrate high resting pressures. This is the fundamental basis of

internal sphincterotomy as the surgical treatment of choice. Manometry is not used routinely in the evaluation process.However, it is extremely useful in evaluating patients with recurrent
recurrent fissures, elderly patients with pre-existing incontinence and multigravid women with possible pre-existing sphincter defects as this allows the surgeon to decide on the procedure of choice.
Manometery
Endoscopy
In patients who are below the age of 50 years, it is reasonable to allow for a trial of conservative or medical treatment before embarking on any endoscopic evaluation. However, persistence of symptoms warrants a sigmoidoscopic evaluation in this group of patients.
On the other hand, any patient above the age of 50 years who presents with per rectal bleeding should be offered a full colonoscopic evaluation before concluding that the symptomatology is fissure related.
CARET (Careful Assessment & Rapid Effective Therapy) Service
At the Colorectal Clinic, we offer a one-stop service that enables us to offer your patient a flexible sigmoidoscopy or a colonoscopy (as required) as part of our specialist consulation. If indicated, anal manometry or endoanal ultrasonography can be performed at the same consult. This service will provide immediate reassurance of the benign nature of the rectal bleeding.