Consulting Surgeons

ANAL FISSURE: FREQUENTLY ASKED QUESTIONS

What is an anal fissure?
Anal fissure is a chronic non-healing wound within the outer portion of the anal canal.

How does it occur?
Small wounds or tears arise frequently as a result of minor injury to the outside portion of the anus, usually caused by hard stools. Most of these tears heal quickly and do not cause significant problems. However, some of the tears do not heal and become chronic wounds. Healing is slowest in the back and the front because the blood supply to the skin of the anus in these areas is not as generous. Pain from the tear causes the muscle of the anus (the sphincter) to involuntarily tighten, or go into spasm, squeezing more blood out of the area and thereby slowing the healing process more. The spasm of the sphincter also makes the stools more hard, causing more pain, more spasm, less blood flow -- a vicious cycle results. When the tear becomes established as a chronic wound, it is classified as an anal fissure.

What are the symptoms?
Symptoms of anal fissure may include pain, bleeding, drainage, and bowel irregularity.

How is it diagnosed?
To diagnose an anal fissure, the doctor will review your symptoms, give you a physical examination concentrating on the anal region, and may use some of the following procedures:

In some cases, these tests cannot be performed in the office and require additional anesthesia such as general anesthesia or spinal anesthesia.

How is it treated?
Anal fissures are treated by measures to improve the pain and increase the blood supply to the anal region. Laxatives are prescribed to soften the stool and sitz baths are advised to keep the area clean, especially after bowel movements.

Conventional treatment consists of surgical procedure called a lateral internal sphincterotomy. In this procedure, the doctor makes a cut in the anal sphincter. This procedure results in relaxation of the muscle, allowing more blood to flow into the area, and the fissure to heal. The main risk of the procedure is occasional accidental fecal soilage occurring in a small percentage of patients. This procedure can sometimes be performed under a local anesthesia.

Modern therapy focuses on using medications and other treatments to accomplish the same effect as surgery. Topical ointments and suppositories are available that improve blood flow to the anal region by relaxing the sphincter muscle and enlarging the blood vessels. These treatments are effective at relieving pain but sometimes are not able to fully heal a fissure.

Injection of BOTOX into the anal sphincter is an effective newer treatment. Botox causes the sphincter to temporarily relax, thereby resulting in the same effect as surgery but without the pain of surgery or the risk of accidental fecal soilage. The effect lasts up to 3 months and can be repeated if the fissure does not heal or recurs. The injections are performed in the doctor's office with minimal discomfort.

What happens if anal fissure is not treated?
A well-established anal fissure will persist until it is definitively treated and healed.

How can I take care of myself?
It is usually advised to avoid constipation by taking stool softeners or bulk laxatives and drinking plenty of water and other fluids. It is also advised to keep the anal region as clean as possible. This can involve taking frequent warm baths (sitz baths) and using clean moist pads to wipe the anal area clean. Over the counter creams and ointments should be avoided unless specifically recommended by your doctor.

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Updated 6-6-06 Id

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