WHAT IS AN ANAL FISSURE?
An anal fissure is a small tear or spilt in the skin lining the anal canal which causes severe pain and bleeding from the back passage. The diagram shows the appearances of anal an anal fissure along with a cross sectional image.
WHAT ARE THE SYMPTOMS OF AN ANAL FISSURE?
The typical symptoms of an anal fissure are extreme pain during defecation and fresh red blood streaking the stool or appearing on the paper after wiping. The pain can persist for several hours after defecation. Patients may try to avoid defecation because of the pain.
WHAT CAUSES AN ANAL FISSURE?
Passage of a bulky hard dry stool can cause a tear in the anal lining, resulting in a fissure. Patients may recall this at the onset of there symptoms. Other causes of a fissure include diarrhoea and inflammation of the ano-rectal area.
Anal fissures may be acute (recent onset) or chronic (present for a long time or recurring frequently). An acute fissure is usually due to altered bowel habits and usually heals up by its self quite quickly without specific medical invention.
A chronic fissure however may be either due to poor bowel habits such as constipation, tight or spastic anal sphincter muscles, or an underlying medical problem. The spasm is thought to be made worse by the pain and actually prevents adequate healing.
Each subsequent bowel action opens up the old wound leading to on going pain made worse with each bowel action.
HOW CAN A FISSURE BE TREATED?
If patients have a short history conservative measures may allow healing. The aim is to avoid passing large hard bulky constipated stools which reduces the trauma to the anal canal. Patients are given a high fibre diet, bulking agents (fibre supplements), mild laxatives, and plenty of fluids to promote the passage of soft stools.
A chronic fissure (lasting greater than a month) may require additional more specific treatment. Depending on the appearance of the fissure, other medical problems such as inflammatory bowel disease or infections may be considered and further tests may be recommended.
Specific treatments of chronic anal fissure aim to reduce the spasm in the anal canal described above and thus allow healing to take place. Medicated ointments which induce relaxation in the ring of muscle in the anal canal can heal up to 70-80% of patients. Ointments include Glyceryl Trinitrate (GTN) and Diltiazem in a paraffin or aqueous base. These ointments can cause dizziness and headaches but these problems settle after about a week.
A recent advance has been the use of BOTOX (botulinum toxin) injections to the anal sphincter (see news section for more details). The advantage of this treatment is that surgery can be avoided in some cases.
If these treatments fail it would be usual for an examination under anaesthetic to be arranged with surgery to weaken the muscle by way of a small cut in the inner ring of muscle. This helps the fissure to heal by decreasing pain and spasm. Cutting this muscle rarely interferes with the ability to control bowel movements and can usually be performed as a day case procedure (without an overnight hospital stay.)
CAN FISSURES LEAD TO CANCER?
No! Persistent symptoms need careful evaluation, however, since conditions other than a simple anal fissure can cause similar symptoms.
If you wish to arrange an appointment with Dr. Rob Churchat Al Zahra Hospital Dubai
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