Anal Fissures

What is an anal fissure?

An anal fissure is a tear or cut in the lining of the anus. Anal fissures are a common problem and may sometimes be confused with hemorrhoids. Anal fissures can affect people of any age group, but are more common in people under age 50.

What are the symptoms of an anal fissure?

Symptoms of an anal fissure include:

  • Sharp pain during and after bowel movements. Pain is often severe.
  • Bright red blood with bowel movements, which may be on the stool, in the toilet bowel, or on toilet paper you have used.
  • Spasm in the sphincter muscles of the anus, caused by irritation of the tear during a bowel movement.
  • An anal fissure may give rise to a “sentinel pile”, which is a skin tag along the edge of the anus next to the fissure. This is sometimes confused with a hemorrhoid.

What causes anal fissures?

A tear in the anal lining can occur with:

  • Hard, dry bowel movements
  • Straining to have a bowel movement when constipated
  • Diarrhea
  • Inflammatory diseases of the anorectal area such as Crohn’s disease

What is the treatment for an anal fissure?

Acute anal fissure

An acute anal fissure is managed with non-operatively and can usually be treated by:

  • High-fiber Diet – Eating foods high in fiber prevents constipation and excessive straining. Good sources of fiber include fresh fruit, raw or cooked vegetables, bran cereals, and whole grain breads.
  • Fluids – Drinking plenty of fluids helps soften bowel movements so they are easier to pass.
  • Warm Soaks – Sitting in warm-water 2-3 times a day for 15 minutes helps prevent spasm of the sphincter muscles and provides pain relief.
  • Medications – Your doctor can prescribe creams or suppositories that help relieve pain, spasm, and inflammation.

Chronic anal fissure

A chronic anal fissure does not heal despite the above measures should be treated with a small simple operation called a sphincterotomy. This procedure is usually done under anesthesia, takes a few minutes, and patients go home the same day as outpatients. During this procedure a few fibers of the internal anal sphincter muscle are cut. This decreases spasm in the muscle and allows the fissure to heal. Most patients have a significant reduction in their discomfort immediately after the surgery, and many can go back to work and resume normal activities the following day. Almost all patients (greater than 95%) have rapid healing after surgery and no further trouble with an anal fissure.

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