An anal fissure (Fissure-in-ano) is a small tear in the skin at the opening of the anus.
What are the symptoms of an anal fissure?
Anal fissure causes severe pain during or after a bowel movement and can last from several minutes to hours. Patients may also have rectal bleeding with the bowel movement either in the toilet bowel or on the tissue paper after wiping.
What causes an anal fissure?
Anal fissure is typically caused by trauma to the anal opening, usually by a hard bowel movement, but can also occur with diarrhea. In most patients, the fissure will heal by itself. Patients with a tight anal sphincter (increased muscle tone) are more prone to developing a chronic anal fissure that lasts from several weeks to months. After a bowel movement, the tight anal sphincter will spasm even more preventing blood flow to the area, thereby preventing healing of the fissure.
Other less common causes of anal fissure are Crohn’s disease, infections or tumors.
What is the treatment of anal fissure?
The majority of fissures can be treated with dietary management and medicine. Dr. Zaghiyan recommends increasing your fiber and water intake by eating more bran, fresh fruits and vegetables, or using fiber supplements (total daily fiber of 25-30 grams). In addition, you should drink plenty of water (8 – 10 glasses/day). The goal is to have soft but bulky and formed bowel movements. Warm baths (or Sitz baths) 3 times a day for 10-20 minutes at a time will soothe the area and relax the anal sphincter to promote healing.
Dr. Zaghiyan can also prescribe ointments to promote relaxation of the anal sphincter and heal the fissure. Chronic fissures may be harder to treat and may require surgery.
Can anal fissure return after it has healed?
Yes. It is common for a healed fissure to return after a hard bowel movement. It is important to continue your high fiber diet and stay well hydrated to keep your stools soft and bulky in order to prevent the fissure from recurring. If the fissure returns you should make an appointment for another exam with Dr. Zaghiyan.
What if I need surgery?
Some chronic fissures may not heal with conservative measures and medical therapy. In this situation Dr. Zaghiyan may recommend surgery. Surgery involves dividing a portion of the internal anal sphincter (lateral internal sphincterotomy) to promote relaxation of the internal sphincter and allow healing of the fissure. This is typically outpatient or same-day surgery. Another option is injection of botulinum toxin (Botox®) into the internal sphincter to promote relaxation. This is also performed in the operating room under anesthesia. There are risks involved with every surgery including bleeding and infection. Rarely, surgery can impair your ability to control gas or stool.
After examination, Dr. Zaghiyan will discuss all of the options with you, and together you can decide on the best, individualized treatment option for you.