Symptoms of Anal fissure
  • Anal pain
  • Bleeding
How is it diagnosed?
  • Analysis of symptoms
  • Inspection of the affected region
  • Sigmoidoscopy
  • Colonoscopy
How can it be treated?
  • Lifestyle changes
  • GTN ointments
  • Diltiazem
  • Surgery
    • Botox Injection
    • Lateral Sphincterotomy

Anal fissure is a common condition where there is a tear in the lining of the anal canal. It can be caused by passage of very hard stools or diarrhoea. An anal fissure that lasts more than six weeks is called a chronic anal fissure.

What are the symptoms?

Anal pain – The area around the back passage is very sensitive and hence a wound in the region results in severe pain.

Bleeding – Whenever you open your bowels the stools can irritate the open wound and result in fresh rectal bleeding.

How is it diagnosed?
  • The diagnosis is usually made by a detailed analysis of the symptom.
  • An inspection of the region may reveal the small tear.
  • Any invasive investigations at this stage can be very painful and may not be necessary, however symptoms of rectal bleeding may need investigation at a future date with a sigmoidoscopy or colonoscopy to ensure the bleeding is not arising from any condition higher up in the bowel.
How can it be treated?
  • Most of the fissures can be treated with simple lifestyle changes such as avoiding constipation and keeping stools soft.
  • 0.2% GTN ointments that help to relax the anal sphincter help improve the blood supply to the region and can help with healing of the wound but may cause headache as a side effect. This can be relieved by taking paracetamol half an hour before using the cream. The second ointment is Diltiazem and the most common side effect of using this is itching around the back passage. These treatments need around 6-8 weeks to work and a second course may be required.
What does surgery involve?
  1. Botox Injection
    Injecting botox around the anal sphincter can help relax the muscle spasm and allow the fissure to heal. Repeated injections may sometimes be required. A common side effect is inability to control the passage of wind immediately after the injection and leakage of stool.
  2. Lateral Sphincterotomy
    This operation involves division of a part of the muscle of the anal canal muscle complex. This helps in relieving the muscle spasm, thus improving the blood supply to the region allowing the fissure to heal. This rarely results in loss of bowel control and maybe needed if Botox injection fail.

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