Anal Fissure

What is an anal fissure?

An anal fissure is a small tear in the skin at the ‘edge’ of the anus. Fissures typically cause pain and often bleed. Fissures are quite common, but are often confused with other causes of pain and bleeding, such as haemorrhoids.

What are the symptoms of an anal fissure?

The typical symptoms of an anal fissure are pain during or after defecation and bleeding. Patients may try to avoid defecation because of the pain.

What causes an anal fissure?

A hard, dry bowel movement is typically responsible for a fissure. Other causes of a fissure include diarrhoea or inflammatory conditions of the anal area. Anal fissures may be acute (recent onset) or chronic (present for a long time or recurring frequently). Chronic fissures often have a small external lump associated with the tear called a sentinel skin tag.

How can a fissure be treated?

Often treating the constipation can cure a fissure. An acute fissure is typically managed with non-operative treatments and over 70% will heal without surgery. Use of stool softeners and increasing oral fluid intake help relieve constipation and promote softer bowel movements, aiding the healing process. Increased dietary fibre may also help to improve diarrhoea. Warm baths several times each day are soothing and promote relaxation of the anal muscles, which can also help healing. Occasionally, special prescription only medications may be recommended and a chronic fissure may require additional treatment.

Will the problem return?

Fissures can recur easily, and it is quite common for a healed fissure to recur after a hard bowel movement. Even after the pain and bleeding has disappeared one should continue to aim for good bowel habits and adhere to a high fibre diet or fibre supplement regimen. If the problem returns without an obvious cause, further assessment may be needed. A colonoscopy may be required to exclude other causes of bleeding.

What can be done if a fissure doesn't heal?

A fissure that fails to respond to treatment should be re-examined. Persistent hard or loose bowel movements, scarring, or spasm of the internal anal sphincter muscle all contribute to delayed healing. Other medical problems such as Crohn’s disease, infections or anal tumours can cause fissure-like symptoms, and patients suffering from ­persistent anal pain should be examined by a colorectal specialist to exclude these conditions.

What does surgery involve?

Surgery is a highly effective treatment for a fissure and recurrence rates after surgery are low. Surgery usually consists of a small operation to cut a portion of the internal anal sphincter muscle (a lateral internal sphincterotomy). This helps the fissure heal and decreases pain and spasm. If a sentinel tag is present, it too may be removed to promote healing of the fissure. A sphincterotomy is most commonly performed as a day case procedure and Mr Tsavellas will discuss the procedure with you in detail during your consultation.

How long does the healing process take after surgery?

Complete healing occurs in a few weeks, although pain often disappears within a week.