What to know about anal fissures
An anal fissure is a wound that occurs in the lowest part of the digestive tract, specifically the anus. It is characterised by intense pain, which usually occurs up to 10 minutes after using the bathroom, and does not respond to conventional painkillers. In this article, consultant colorectal surgeon Ms Lynn Stevenson explains how anal fissures occur and how they’re treated.
Anal fissures are small tears that form along the thin tissue around the sphincter of the anus. It is commonly caused by straining when trying to pass stool, passing particularly large stool, long periods of diarrhoea, childbirth, and anal intercourse. Less commonly, they can be caused by inflammatory bowel diseases, anal cancer, syphilis, and HIV. They are most common in young children but can affect anyone of any age.
What are the signs of anal fissures?
The symptoms of anal fissures include:
- Pain during and after bowel movements, which can last for several hours,
- Bright red blood in the stool.
- Visible tears or cracks around the skin of the anus.
- Small lumps or skin tags around the fissure.
- Spasms of the sphincter
Anal fissures and haemorrhoids are often confused, but haemorrhoids are when internal blood vessels and tissues of the anus. However, they are similar in that both can be caused by excessive straining.
What does anal fissure treatment involve?
Anal fissures, in most cases, can be treated with at-home remedies. Patients are recommended to eat more fibre and drink more fluids to soften their stool, and to keep the anus clean and soothed by soaking the bottom in warm water multiple times daily, particularly after using the bathroom.
However, if the fissures do not improve, then medical intervention may be necessary.
This can include topical creams and medications like:
- Nitro-glycerine to promote healing and relax the sphincter.
- Anaesthetic creams to help manage pain.
- Botox injections to paralyse and relax the sphincter.
In very extreme cases, fissures that are recurrent, or when the fissures are at risk of becoming infected, then surgery can be considered, such as a surgery called lateral internal sphincterotomy, which consists of making a tiny incision on the internal anal sphincter with a scalpel or an electrocautery tool.
Afterwards, the post-operative care is relatively simple. There will be some pain, which can be managed with painkillers, and some discharge like bleeding and anal fluids. Some patients will experience constipation, due to the anaesthetic. The patient themselves needs to keep the area clean and take antibiotics. A patient can return to normal working life without major discomfort within three days of the procedure.
With a correctly performed internal lateral sphincterotomy, it is unlikely that anal fissures will reoccur.
If you are struggling with anal fissures, you can consult with Ms Stevenson on Top Doctors.