Anal Fissure

An anal fissure is a small tear in the thin, moist tissue, called the mucosa which lines the anus. An anal fissure may occur when a hard or large stool is passed during a bowel movement.

What are anal fissure symptoms?

Anal fissures typically cause severe pain and bleeding with bowel movements. The fissure may also lead to spasm of the ring of muscle at the end of the anus (anal sphincter). These spasms will decrease the blood supply to the area of the tear leading to impaired wound healing. The pain associated with the act of passing stool can lead to the patient avoiding stooling and subsequent constipation developing. Passing a large, hard stool will, in turn, worsen the fissure and so a vicious cycle can ensue leading to a chronic fissure.

Other symptoms of anal fissure may include a small lump of skin or skin tag next to the tear, and a burning or itching sensation in the anal area.

How is an anal fissure treated?

Anal fissures are very common in young patients but can affect people of any age. An anal fissure usually heals on its own within four to six weeks. If it doesn't, medical treatment or surgery can relieve discomfort.

• Medical treatment:
  Anal fissures often heal within a few weeks if steps are taken to keep stools soft, such as increasing the intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter, improve blood supply and promote healing. If the above measures fail Dr Cooper may recommend the following treatments:
  
  • Externally applied nitroglycerin
    to help relax the anal sphincter thereby increasing blood flow to the area of the anal fissure and promote healing. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache.
  • Steroid creams
    to help relieve discomfort.
  • Botulin toxin type A (Botox) injection
    to paralyze the anal sphincter muscle and relax spasms.
  • Blood pressure medications
    which can help relax the anal sphincter. These medications may be taken by mouth or applied externally. Dr Cooper may recommend this when nitroglycerin is not effective or causes significant side effects.
• Surgery:
  If the anal fissure has become chronic and is resistant to other treatments, or if the anal fissure symptoms are severe, Dr Cooper may recommend surgery. During an anal fissure surgery procedure, the surgeon will cut a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Surgery has a small risk of causing incontinence.