1 General introduction 29 Brown et al.110 found that patients are more likely to attend PFPT when referred on their initial consultation with the physician than those who were referred later. A multidisciplinary setting was associated with higher rates of PFPT attendance. Currently, PFPT is not recommended in the guidelines as a treatment option for CAF.8,81,82 Surgical options Although this thesis is only focused on the conservative management of CAF, various surgical procedures should be mentioned. Fissurectomy is the surgical procedure of choice in the Netherlands, followed by lateral internal sphincterotomy.111 Lateral internal sphincterotomy is the preferred treatment for refractory anal fissures and is still considered the golden standard because of superior healing rates,81,82 although fecal incontinence is a potential risk.7,86,112-114 In this regard, the development of new treatment possibilities having the same or better outcome but with less side effects remains an actual assignment. Pelvic floor physical therapy could bridge the gap between conservative management and surgery.
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