What Is An Anal Fissure?
An anal fissure is a small, oval-shaped tear in skin that lines the opening of the anus. It causes severe pain and bleeding during bowel movements. It is quite common, but often confused with other causes of pain and bleeding, such as haemorrhoids.
What Are The Symptoms of Anal Fissure?
The symptoms include severe pain during, and especially after a bowel movement, lasting from several minutes to a few hours. There might be bright red blood from the anus that can be seen on toilet paper or on the stool. Between bowel movements, patients with anal fissures are often symptom-free. They are fearful of having a bowel movement and may try to avoid defecation due to the pain.
What Causes Anal Fissure?
They are usually caused by trauma to the inner lining of the anus. Patients with tight anal sphincter muscles (i.e. increased muscle tone) are more prone to developing anal fissures. A hard, dry stool is typically responsible; but loose stools and diarrhoea can also be the cause.Following a bowel movement, severe anal pain can produce spasm of the anal sphincter muscle, resulting in a decrease in blood flow, thus impaired healing of the wound. The next bowel movement results in more pain, anal spasm, decrease blood flow to the area, and the cycle continues. Treatments are aimed at interrupting this cycle by relaxing the anal sphincter muscle to promote healing of the fissure.
Other less common causes include inflammatory conditions and certain anal infections or tumours. Anal fissures may be acute (recent onset) or chronic (present for a long period of time). Chronic fissures may be more difficult to treat, and usually will have an external lump (sentinel pile or skin tag).
What Is The Treatment Of Anal Fissures?
Majority do not require surgery. The treatment of acute fissure consists of high fiber diet, increased water intake and stool softeners. Topical anaesthetics for pain and warm sitz baths for 10-20 minutes several times a day (after bowel movements) are soothing and promote relaxation of anal muscles.Other medications (nitroglycerin, nifedipine, diltiazem cream) can be prescribed to allow relaxation of the anal sphincters. Chronic fissures are generally more difficult to treat and may need surgical treatment.
Will The Problem Return?
Yes. It is quite common for a fully healed fissure to recur after a hard bowel movement or other trauma. It is very important to continue good bowel habits and a diet high in fiber as a lifestyle change. If the problem returns without an obvious cause, further assessment is warranted.What Does Surgery Involve?
Surgical options include Botox injection into the anal sphincter and surgical division of a portion of the internal anal sphincter (lateral internal sphincterotomy). Both of these procedures can be performed as outpatient, same-day procedures. The goal of these surgical options is to promote relaxation of the anal sphincter, thereby reducing anal pain and spasm, allowing the fissures to heal. Botox injection results in healing in 50-80% of patients while sphincterotomy is reported to be >90% successful. All surgical procedures carry some risk; and your colorectal surgeon will discuss these risks with you to determine the appropriate treatment for your particular situation.
How Long Is The Recovery After Surgery?
Complete healing can take up to 6-10 weeks. However, acute pain after surgery often disappears after a few days. Most patients will be able to return to work and resume daily activities in a few short days after surgery.Can Fissure Lead to Colon Cancer?
Absolutely NO. Persistent symptoms, however, need careful evaluation since other conditions can cause similar symptoms. A colonoscopy may be required to exclude other causes of rectal bleeding.
Source: ASCRS
