Anal fissures

An anal fissure is a small tear or cut of the tissue on the inside of the anal canal. They can be extremely uncomfortable and painful. Simple, every day movements such as walking can cause severe pain. A bowel movement can cause such excruciating pain that most people will try to suppress the urge, leading to constipation and diverticulosis.

Symptoms Of Anal Fissures:

Pain when going to the bathroom
Rectal Itching
Rectal bleeding
Anal discharge
Swelling

Anal Fissure Causes

Constipation (dry, hard bowel movements)
Diarrhea
Tight sphincter muscles
Inflammation of the rectal area
Each of these symptoms can cause the anus to become irritated and dry cause a tear in the anal lining.

Diagnosing Anal Fissures

Anal fissures are often mistaken for hemorrhoids. Even though symptoms for each are very similar, treatment is very different. It is crucial to get a correct diagnosis. Self-diagnosis is not recommended. A Doctor will study the patient's symptoms and bowel habits.


A diagnosis can be made without a physical examination (if the area is too tender to touch) however, a more accurate diagnosis can be made once the examination is complete.

There are two types of anal fissures: acute or chronic. An acute fissure is one that is recent and is usually caused by altered bowel habits such as bouts of constipation and/or diarrhea. They do not last for a long periods of time and are not re-occurring.




A chronic fissure is one that lasts for long periods of time and re-occurs frequently. They can be caused by unhealthy bowel habits, spastic or tight anal muscles, scarring, or an underlying medical issue.

Treatment For Anal Fissures

Treatment will vary depending on the type of fissure. An acute fissure (recent onset) can be treated with simple over-the-counter remedies. A chronic fissure (re-occurring or present for long periods of time) may need surgical treatment.

Treatment for acute fissures includes diet and lifestyle changes. Since constipation is one of the main causes of acute fissures, an increase in fiber intake will soften the stools making them easier to pass.


Also, an increase in fluids (especially pure water) will promote the smooth passage of soft stools. Softer stools mean the fissures are less irritated and your body will be able to heal on its own.

One other home remedy is to soak in a warm bath (several times a day if possible). The warm water helps relax the muscles and provides relief from spasms.

Special Note: Some creams and ointments that contain steroids or anesthetics can reduce inflammation and pain, which also allows for quicker healing.

Chronic Fissures may need additional treatments. Testing may be done to determine if there is an infection or another reason why the fissure is not healing.





Fissures that continue to cause pain and do not heal may need to be corrected with surgery. Those suffering from chronic fissures usually suffer from tighter muscles along the anal canal.




Surgery involves cutting a portion of the internal anal sphincter muscle. This provides relief from the pressure in the anal canal. Stools will then pass more easily and with less irritation, promoting healing and prevention of future fissures. Surgery is usually a day procedure and done under general anesthesia.

Anal Fissure Prevention

There are several steps you can take to prevent future fissures from occurring. If followed correctly and methodically, these steps will also help revitalize your overall health and well being.


Consume 25-30 grams of fiber daily.

Never put off the urge to have a bowel movement.

Drink ½ your body weight in ounces daily – purified or distilled water only.

Do not use chemical laxatives or enemas to assist in bowel movements.

Do a complete colon cleanse on a seasonal basis.

Chronic Fissure surgeries

If a fissure persists even after treatment, it may become a chronic problem. A chronic fissure may need to be treated with surgery. Two different types of surgery are done for fissures -- anal dilation and lateral internal sphincterotomy (LIS).

Anal dilation may be a choice for some patients, but it is being used less often due to the potential of incontinence as a complication. During anal dilatation, the anal canal is stretched.

More often, the LIS surgery is used. LIS is usually done with a general anesthetic on an outpatient basis. In the procedure, a portion of the anal canal muscle is cut. The fissure itself is not removed, but any muscle spasms in the anus sphincter will be relieved. This will allow the fissure to heal at a cure rate of more than 90%.

After surgery, it is important to keep the anal area clean and dry. Moist wipes instead of toilet paper and a stool bulking agent may be recommended.

Sphincterotomy

Lateral internal sphincterotomy involves stretching or cutting the internal sphincter, the muscle that restricts and relaxes when stool passes from the body. Cutting the muscle prevents spasm and temporarily weakens the muscles, and this in turn helps the area to heal. The surgeon removes the fissure and any underlying scar tissue.

The surgery can be performed under local anesthesia, which involves injecting the immediate area with a numbing agent similar to that used at the dentist's office, or spinal anesthesia, which numbs the entire lower body. In some cases, general anesthesia may be used, which renders the patient unconscious. The choice of anesthesia depends on patient and physician preference, the patient's health, and the standard practice of the particular facility.

The patient is positioned on the table so that the anus and rectal area are exposed. This can be done face down, with the buttocks slightly elevated, or supine (on the back) with the legs held up in stirrups. After anesthesia is administered, the area is cleaned with an antiseptic solution.

The operation takes about 20 to 30 minutes. The wound is then sutured closed, usually with stitches that dissolve in time. Most patients can go home the same day.