An anal fissure is a tear in the skin around the opening of the anus (the last part of the digestive tract that controls the removal of stools). It is associated with pain and bleeding during bowel movements. The condition is more common in young infants but it can happen at any age.
They are usually caused by trauma or injury to the anal canal while passing hard or large stools, constipation, diarrhea or childbirth.
Most anal fissures can be diagnosed by a physical examination which involves viewing the anal region and reviewing your medical history. In some cases, diagnosis is done by digital rectal examination or using an instrument called an anoscope. The anoscope is a short instrument with a lighted tube which can help the doctor view and examine the fissure.
They usually heal on their own in a few days or weeks (acute), but in cases when it doesn’t heal even after 6 weeks (chronic), medical treatment or surgery is recommended.
The typical symptoms include pain during and several hours after bowel movement. Even though the tear caused by an anal fissure is small (about 1cm); the condition is painful and may persist for an hour or more after passing faeces. The severe pain may make patients apprehensive to the point of avoiding defecation, which further aggravates the condition. Pain is usually more intense in acute anal fissure.
Other symptoms include:
1) Blood in the stools, on the toilet tissue or in the bowl
2) Muscular spasms at the end of the anus
3) Cracked or ripped anal skin
4) Itchy fissures
5) Yellow discharge that has an unpleasant odour
6) Chronic anal fissures can grow deeper into the tissue and form ulcers, which can further delay the healing process.
Treatment usually involves adopting simple measures to keep your stool soft such as by increasing fiber and fluid intake. Soaking in warm water for 10 – 20 minutes as often as possible, particularly after bowel movements, also helps with healing and reducing discomfort. If symptoms still persist, further treatment is required which involves using steroid creams and botox injections. Topical anesthetics and pain medication may also be prescribed to control pain.
Surgery is recommended if the symptoms do not respond to conservative treatment. The surgical procedures include
1) Lateral internal sphincterotomy
2) Fissurectomy which involves surgically removing the anal fissure leaving an open wound to heal naturally and
3) Advancement anal flaps which involves replacing broken tissue with healthy tissue derived from a different part of the body
Lateral sphincterotomy is the most common surgical procedure indicated for the treatment of anal fissures. The surgery is usually performed under the effect of general anesthesia in an outpatient setting or as an office procedure where you can go home the same day of the surgery. The surgery involves making a small cut or incision in the sphincter muscle to reduce the tension in your anal canal which allows the anal fissure to heal. The incision can be closed or left open to heal.
After the surgery you will be given some pain killers for pain relief. Remember to remove the wound dressing before having a bowel movement. Complete recovery from anal fissure surgery might take several months, but this varies between individuals.
As with any surgery the anal fissure surgery involves certain complications such as risk of infection and anal incontinence which includes inability to control gas and loss of solid stool.