An anal fissure is a split in the skin lining the anal canal. The predominant symptom of an anal fissure is pain, especially when opening the bowels. It is frequently associated with bleeding, the blood being seen on the toilet paper and sometimes dripping into the toilet bowl.
The cause of an anal fissure is still somewhat of a mystery, but it is thought to be caused by excessive straining on a hard stool or sometimes by excessive opening of the bowels with diarrhoea, often associated with a tummy upset.
Initially the fissure will be described as acute. At this stage keeping the stools soft with a laxative or stool softener and avoiding straining may be enough to promote healing. If not the fissure will split on repeated occasions and start to form scar tissue. This longstanding or chronic fissure often fails to heal without medical help. The reason for this is that in response to the pain, the muscles around the anus, the sphincters, go into spasm, to try to prevent further damage, but in so doing also prevent healing. This is very similar to the muscles of the eye closing the eye tightly when a piece of grit goes in, to protect the eye from further damage, but at the same time preventing removal of the grit.
Frequently, ointments and creams designed to help heal the fissure will be prescribed, but the success rate is in the order of about 60% and on occasions the fissure may heal and the split again.
When topical creams and ointments have failed, surgical intervention may be necessary. The most commonly performed procedure is a sphincterotomy (a cut in the sphincter muscle to relax the muscle and reduce the spasm) but is associated with minor incontinence and leakage in up to 8% of cases. Nowadays, newer approaches exist with a success rate equal to that of a sphincterotomy, about 90%, without the need for cutting the muscle.
Fissures can occur in conditions such as Crohn’s disease and when taking some cardiac medications and should be managed with expert medical help.
For a consultation and a more detailed explanation of anal fissure and fissure surgery please contact Dr Gold.