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Anal Fissure

An anal canal can be defined as a short tube of 2.5–3.5 cm long surrounded by muscle at the end of the rectum. It is the final segment of the gastrointestinal tract between the rectum and the anus. At the same time defining an anal fissure is a small rip or tear in the lining of the anal canal which may occur when hard or large stools are passed during a bowel movement. Due to the stretching of anal canal, it leads to bigger tears in the anal canal. However, fissures being common they are often confused with other anal conditions, such as haemorrhoids.

Symptoms & causes of an anal fissure

Symptoms of an anal fissure:

1. Ripped skin around your anus
2. A skin tag, or small lump of skin, next to the tear
3. Sharp pain in the anal area during bowel movements
4. Streaks of blood in stools or on toilet paper after wiping
5. Burning or itching in the anal area

However, this pain may last for several minutes to a few hours. As a result, many patients may try not to have bowel movements to avoid the pain.

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Causes of an anal fissure;

1. Passing large or hard stools
2. Constipation and straining during bowel movements
3. Chronic diarrhoea
4. Anal intercourse
5. Childbirth

However, there are also some less common causes of fissures like inflammatory bowel disease, anal infections, tumours, anal cancer, HIV, tuberculosis, syphilis etc.

Treatment of an anal fissure

However, not being a very serious medical issue, an anal fissure does not last for months if steps are been taken to keep the stool soft or avoid having constipation. This is done by drinking lots of water at the same time, soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help to relax the sphincter and promote healing.

After applying all these remedies if the symptoms persist then one can opt for the medical treatment.

anal fissure surgery treatment

Nonsurgical treatment

1. Application of Ointments

Applying anaesthetic creams likelidocaine hydrochloride (Xylocaine) can provide relief from pain and anal irritation.

2. Application of Nitroglycerin

This is one of the most effective medical treatment as it is usually opted when all other treatment fails. It aids to increase the blood flow to the fissure and promote healing that in turn helps in relaxing the anal sphincter.

3. Application of Botulinum toxin type A (Botox) injection

These injections are used to paralyze the anal sphincter muscle and relax spasms in order to reduce the pain.

Surgical treatment

Sometimes an anal fissure, get worse and demands for a surgical treatment. The surgery is usually opted to relax the anal sphincter muscle in order to reduce the pain and spasms, allowing the fissure to heal. Lateral Internal Sphincterotomy (LIS) is a surgical procedure which is considered very effective and is usually performed by cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing.

Post-treatment prognosis

It generally takes 6 to 10 weeks for proper healing of the patient who has gone through any medical or surgical treatment. At the same time, it is important to maintain good bowel habits and eat a high-fibre diet for avoiding hard stool. The continued hard or lose bowel movements will scar, or spasm the internal anal muscle which can delay the healing process. Fissures can often come back whenever there is a hard bowel movement or trauma to the anal canal.

Anal fissure and colon cancer

Anal fissures not being a much serious medical issue does not increase the risk of colon cancer nor cause it. In fact, people suffering from colon cancer may develop anal fissures. However, more serious conditions can cause similar symptoms.

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Old Rajinder Nagar, New Delhi
Delhi Laparoscopic Surgery Clinic
VBS Medics, D-148, near Manav Rachna School, Block D, Sector 51, Noida, Uttar Pradesh 201307
Ahuja Clinic
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About Anmol Ahuja

DNB (Gen Surgery), FNB (Minimal Invasive Surgery), FMAS, Fellowship in ColoRectal Surgery (Taiwan)

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Copyright by Dr. Anmol Ahuja. All rights reserved.

Copyright by Dr. Anmol Ahuja. All rights reserved.