Anal Fissure

Overview

An anal fissure is a small tear in the skin lining near the anus opening. They are caused by difficult or hard bowel movements that cause severe pain or bleeding. Your doctor may advise you to make a few dietary changes for soft stools, as well as use topical anaesthetics to relieve pain. If surgery is required, your surgeon will work to relax the anal area to reduce anal pain.

Causes of Fissures

Injury to the skin at the anal opening caused by a hard, dry bowel movement is the most common cause of an anal fissure. Digital insertion (during examination), foreign body insertion, and anal intercourse are some of the other causes. During childbirth, pregnant women may also develop a fissure. They can be acute (recently developed) or chronic. Chronic fissures occur frequently or for an extended period of time and are frequently associated with a small external lump known as a skin tag or sentinel pile.

Treatment options available for Anal Fissure:

Anal fissures usually heal in a few weeks if you take steps to keep your stool soft, such as increasing your fibre and fluid intake. Bathing in warm water for 10 to 20 minutes several times a day, particularly after bowel movements, can aid in sphincter relaxation and healing.

Conservative management: Medical management heals at least 50% of anal fissures, which includes topical ointments, sitz baths, dietary changes (i.e. incorporating a high fibre diet and avoiding foods that are poorly digested like maida, popcorn, and chips), drinking plenty of fluids, and using stool softeners/ laxatives.

Surgery is used to treat fissures that have not responded to other treatments. There are two options available:

Chemical Internal Sphincterotomy: A minimally invasive technique for relaxing the anal muscle that involves injecting chemicals into the anal sphincter muscle and partially paralysing it.

Lateral Internal Sphincterotomy: In this procedure, a portion of the anal sphincter muscle is divided, which aids in the healing of the fissure and reduces pain and spasm. If there is a sentinel pile present, it is removed to promote healing. It is a short surgical procedure that can also be done as an outpatient procedure. The chances of this happening again are almost nil. It is the most effective treatment option for fissures that are not healing.