Anal Fissure
General Surgery
What is an anal fissure?
An anal fissure is a papercut or “tear” in the skin around the anus. They are more commonly found at the front or back of the anus. Fissures in the lateral positions are rare. Other unusual causes need to be considered if this is the case.
How is it caused?
• Hard and dry stools
• Diarrhoea
• Child birth
What symptoms will I experience?
A fissure can be acute or chronic. Severe pain in an acute fissure is often described as passing broken glass or barbed wire. Bleeding is not significant in terms of amount but there is usually a trace of fresh red blood on the toilet paper. A chronic fissure is less painful and usually described as a discomfort.
How is it treated?
• Increase your fibre and water intake: Most fissures get better by increasing the fibre and water intake. Pain can be managed with simple regular analgesics.
• Simple non-constipating painkillers
• Simple laxatives
• Chemical sphincterotomy: In some cases, a tube of ointment (GTN or Diltiazem) may be prescribed by your doctor. This ointment relaxes the muscles of the anus which are in a heightened state of spasm. This is also known as a chemical sphincterotomy. Each course will be for 6 weeks, and it can be repeated if your condition improves. Due to sideeffects (eg: headache, fainting etc), patients generally apply the cream once or twice a day, compared to the recommended 3 times a day. Repeated courses of the ointment are effective in 60% of cases. Usually these methods are tried for a period of three months.
Botox injections: If there is no improvement in your symptoms after this time then your specialist may discuss botox injections. This is usually done under general anaesthetic. At the same time, diagnosis and position of the fissure can be confirmed. The short term results of botox are as good as a chemical sphincterotomy. Botox is safe but on occasion some people experience allergic side effects. Most patients will merely experience mild flu-like symptoms.
If there is no improvement, your doctor may discuss surgical treatments to release the spasm in the muscles of the anus (surgical sphincterotomy).
