An anal fissure is a small split or tear in the thin, moist tissue (mucosa) that lines the anus (lower rectum). It causes pain and bleeding during bowel movement.
Although anal fissures are very common in young infants but it can affect people of any age. The rate of anal fissures drops with age. It does not lead to any serious problem and generally heal on their own.
Anal fissures occur due to injury or trauma to the anal canal. Injury can happen because of any of the following reasons:
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Passing large or hard stools
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Chronic constipation
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Straining during bowel movements
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Chronic diarrhea
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Inflammation of the anorectal area, caused by Crohn’s disease or another inflammatory bowel disease
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Childbirth
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Rectal intercourse
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Decreased blood flow to the area in older adults
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Excessive tension in the sphincter muscles that control the anus
Anal fissure can be a painless wound that may bleed from time to time but neither causes any symptoms nor does it heal. Other than this some patient experience severe symptoms like:
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Severe, sharp and stinging pain during and after bowel movements
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Burning sensation that lasts for several hours after a bowel movement
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Small spot of bright red blood toilet paper or a few drops in the toilet bowl after a bowel movement
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Itching or irritation around the anus
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A visible crack in the skin around the anus
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Spasms in the ring of muscle at the end of anus
First of all, doctor will make a note of patients complaints followed by physical examination that may include:
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Looking at the fissure by gently separating the buttocks
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A digital rectal examination
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Anoscopy
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Flexible sigmoidoscopy
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Colonoscopy
Most of the anal fissures often heal on their own within a few weeks if the individual follows dietary and lifestyle habits to soften the stool. Further treatment is required if the patients symptoms persists.
⦿ Warm water sitz bath for healing or cleansing
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Externally application of nitro-glycerine to increase blood flow and promote healing
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Steroid creams to relieve discomfort
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Botox injection to paralyze the anal sphincter muscle and relax spasms
Blood pressure medications to relax the anal sphincter
Surgery : Surgery is recommended for those patients whose fissure becomes resistant to other treatments or their symptoms become severe. Lateral internal sphincterotomy is performed in which surgeon will cut a small part of the anal sphincter muscle to relax the spasm, reduce pain and promote healing.
Fissurectomy by laser is the most advanced procedure to treat fissures. Laser energy is used in this procedure and has become very popular in recent times.
⦿ More effective than open surgical Fissurectomy
Relatively shorter treatment time
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Relatively painless procedure
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Relives the patient discomfort
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Patient can return to normalcy in a few days
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Lesser chances of infection
