An anal fissure is a cut in the lining of the anal opening which causes pain and often bleed during bowel movements.
What are the symptoms?
Anal fissures usually present with a sharp, stinging pain during or after bowel movements with fresh bleeding. The pain may last for a few hours after defecation.
What are the causes?
The most common cause of the development of an anal fissure is injury to the skin at the anal opening due to a hard, dry bowel movement. Other causes include digital insertion (during examination), foreign body insertion or anal intercourse. Pregnant women may also develop a fissure during childbirth.
Anal fissures may be acute (recent onset) or chronic. Chronic fissures recur frequently or are present for a long time and are often associated with a small external lump called a skin tag or sentinel pile.
Usually, the doctor can make a diagnosis based on the symptoms and a simple look at the anal opening. Sometimes, a digital rectal examination or an anoscope may be required for diagnosis.
Atleast 50 percent of anal fissures heal by medical management which include topical ointments, sitz baths, dietary modifications (i.e. incorporating a high fibre diet and avoiding foods that are not well digested like maida, popcorn , chips), drinking plenty of fluids, using stool softeners/ laxatives.
Usually, acute anal fissures heal in a few days or weeks however, a chronic fissure may take upto 6 weeks to heal.
Fissures may recur due to hard bowel movements. Patients with history of fissures are advised to maintain appropriate bowel habits in particular, high fibre diet and high consumption of liquids.
The patient may need to consider surgery if the fissures do not respond to medical management. The two options available are:
- Chemical Internal Sphincterotomy
It is a minimally invasive approach to relax the anal muscle by partially paralyzing it by injecting chemicals into the anal sphincter muscle.
- Lateral Internal Sphincterotomy
In this surgery, a portion of the anal sphincter muscle is divided which helps the fissure to heal and decreases the pain and spasm. If a sentinel pile is present, it is removed to promote healing. It is a quick surgical process and can also be performed as a short outpatient procedure. The chances of recurrence are almost nil. It is the most effective treatment option for non healing fissures.