Anal Fissure

What is anal fissure?

An anal fissure is a small rip or tear in the lining of the anal canal (lowest part of gut tube after rectum and surrounded by muscles). It can be excruciatingly painful, and can make defecation fearful experience. The fissure can be acute ( present for less than 6 weeks) or chronic ( persist after 6 weeks or recurrent).

What are the symptoms of anal fissure?

It usually causes a sharp, severe pain like passing glass or razor blade when having a bowel motion. The pain usually last for few minutes to hours. The pain can also be brought on with sitting or driving, and can be more debilitating than the painful bowel motion itself. Associated with pain is small amount of fresh bleeding per rectum or mucus discharge sometimes. The chronic fissure can be associated with sentinel pile (Skin tag at the end of fissure).

What causes anal fissure?

The fissure usually starts after episode of constipation or severe episode of diarrhoea. However, can be associated with Childbirth, Crohn’s disease, trauma, surgery for haemorrhoids or rarely anal cancer. Spasm of internal anal sphincter results in ischaemia of mucosa and prevent healing of fissure.

How do we treat anal fissure?

An acute fissure (present for less than 2-6 weeks) may improve with increased fluid and fibre intake, warm baths -10-20 mins few times a day, stool softeners, topical lignocaine ointment and simple pain killers. The topical ointments like Rectogesic or Diltiazem address the spasm to hopefully allow healing.

On the other hand, the chronic anal fissure will not usually typically respond to topical creams and may require different treatment.

Treatment for a non-resolved acute fissure and chronic fissure is tailored to individual circumstances and treatment goals. Options include the injection of Botox (Botulinum toxin), Lateral internal sphincterotomy (a small cut in the internal sphincter) or excision of fissure and closure with advancement flap. In case of chronic fissure, it is important to rule our sinister pathology like cancer by consulting specialist.