What is Anal Fissure?

An anal fissure is a small tear in the thin, moist lining (mucosa) of anus.

Most anal fissures usually get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication/ ointment or, occasionally, surgery. Sometimes people get confused and consider them hemorrhoids.

If a fissure Goes Untreated, then there will be complications. Therefore, it is important to approach the doctor as soon as possible

What Are The Symptoms Of Anal Fissure?

An anal fissure can occur when you pass hard or large stools during a bowel movement. Anal fissures usually cause pain and bleeding with bowel movements. You may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

• Pain during bowel movements, sometimes severe

• Pain after bowel movements that can last up to several hours

• Bright red blood on the stool or toilet paper after a bowel movement

• A visible crack in the skin around the anus

• A small lump or skin tag on the skin near the anal fissure

What Are The Causes Of Anal Fissure?

• Traumatic bowel movements

• Anal penetration

• Constipation

• Anal fissure postpartum

• Persistent diarrhea

• A sexually transmitted disease

• Less common causes of fissures include inflammatory bowel disease, anal infections, trauma or tumors.

What Is The Treatment Of Anal Fissure?

If the condition is not serious, then local medication will heal it and help you relieve the pain. For chronic non healing fissure, sometimes more tests required including Colonoscopy. Sometimes surgery called Internal Anal Sphincterotomy.

Non-surgical Treatments:

Your doctor may recommend:

Externally applied nitroglycerin compound cream to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Other topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief.

Blood pressure medications, such as oral nifedipine or diltiazem (Cardizem) can help relax the anal sphincter when used locally in the form of ointment.

Surgical Treatment:

Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. Surgical options include Botulinum toxin (Botox®) injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing but has minimal risk of incontinence.

Your colon and rectal surgeon will find the best treatment for you and discuss the risks of surgery. Both types of surgery are typically done as same-day outpatient procedures.

Lateral Internal Sphincterotomy where only internal muscles cut to help with fissure healing.

What Is Post-Treatment Prognosis?

Most patients can return to work and go back to daily activities a few days after surgery. Complete healing after both medical and surgical treatments can take 6 to 10 weeks. Even when the pain and bleeding lessen, it is important to maintain good bowel habits and eat a high-fiber diet. Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing.

Fissures often come back. A fully healed fissure can come back after a hard bowel movement or trauma. Medical problems such as inflammatory bowel disease (Crohn’s disease), infections, or anal tumors can cause symptoms similar to anal fissures. If a fissure does not improve with treatment, it is important to be evaluated for other possible conditions.

Can Anal Fissures Lead To Colon Cancer?

Anal fissures do not increase the risk of colon cancer nor cause it. However, more serious conditions can cause similar symptoms. Even when a fissure has healed completely, your colon and rectal surgeon may request other tests. A colonoscopy may be done to rule out other causes of rectal bleeding.