Anal Fissure

Anal Fissure

An anal fissure is a tear in the skin around the opening of the anus (the last part of the digestive tract that controls the removal of stools). An anal fissure is associated with pain and bleeding during bowel movements. Although anyone can experience it; it is more commonly seen in infants.

Anal fissures can be caused because of trauma or injury to the anal canal while passing hard or large stools, constipation, straining during bowel movements or childbirth. It can occur independently or in association with other conditions like chronic diarrhea, HIV, anal cancer, tuberculosis and herpes.

The typical symptoms of an anal fissure include pain during and several hours after bowel movements. The severe pain may make patients avoid defecation, which further aggravates the condition. Other symptoms include:

  • Blood in the stools
  • Cracked anal skin
  • Itchy fissures
  • Yellow discharge that has an unpleasant odor

Most anal fissures can be diagnosed by report of symptoms and by viewing the anal region. In some cases diagnosis is done by digital rectal examination or using an instrument called an anoscope. Digital rectal examination involves inserting a gloved finger into the anal canal. The anoscope is a short instrument with a lighted tube which can help your doctor view and examine the fissure.

In most patients, an anal fissure heals on its own in a few days or weeks (acute), but in cases when it doesn’t heal even after 6 weeks (chronic), medical treatment or surgery may be recommended.

Adopting simple self-help measures for making stools easier to pass is helpful in healing existing fissures and also reduces your chances of developing fissures in the future. These measures include:

  • Increasing fiber intake by eating foods rich in fiber, like whole grain breads, fruits, vegetables, etc.
  • Drinking plenty of water and exercising regularly.

Soaking in warm water for 10 – 20 minutes as often as possible, particularly after bowel movements, helps with healing and reducing discomfort. Steroid creams, other topical applications and botox injections may be prescribed to reduce discomfort, improve blood circulation and relax the sphincter muscles of the anus. Topical anaesthetic and pain medication may also be prescribed to control pain. Surgery is usually the last resort when other treatments do not provide the needed relief. Some of the surgical procedures include:

  • Lateral internal sphincterotomyinvolves making a small cut in the sphincter muscle to reduce the tension in your anal canal which allows the anal fissure to heal.
  • Fissurectomyinvolves surgically removing the anal fissure leaving an open wound to heal naturally.
  • Advancement anal flapsinvolve replacing broken tissue with healthy tissue derived from a different part of the body.

Just like other surgical procedures, fissure surgery is also associated with a small risk of complications such as temporary or permanent loss of bowel control.