Anal Fissures

Anal fissure is a small tear in skin that lines the opening of the anus. Fissures usually cause severe pain and bleeding with gut movements. Fissures are quite common in the general population, however are often confused with other causes of pain and bleeding, like hemorrhoids.

Most anal fissures occur in the posterior midline of the anus with about less occurring in the anterior (front) midline. But in rare cases, patients may actually have fissures in each the front and also the back locations.

Symptoms

The typical symptoms of an anal fissure include pain and bleeding with gut movements. Patients have acute pain during, and after bowel movement, lasting from few minutes to a couple of hours. Patients often notice blood from the anus that can be seen on the toilet paper or on the stool.

Causes

Fissures are typically caused by trauma to the inner lining of the anus. A hard, dry bowel movement is usually responsible, however loose stools and diarrhea may be the cause. The stirring trauma to the anus leads to severe anal pain, anal sphincter spasm and a subsequent increase in anal sphincter muscle pressure.

Anal fissures may be acute or chronic. Acute fissures may have the appearance of a simple tear in the anus, but in chronic fissures, swelling and scar tissue can present. Chronic fissures are also more difficult to treat and may also have an external lump associated with the tear, known as a sentinel pile or skin tag, as well as additional tissue just inside the anal canal, mentioned as a hypertrophied papilla.

Treatment

Sphincterotomy

Precise and controlled division of the internal anal sphincter muscle is an extremely effective and normally used method to treat chronic and refractory anal fissures, with success rates reported to be over 90th. Recurrence rates after sphincterotomy are extremely low when properly performed by an operating surgeon. The surgery is a same-day procedure. The main risks of internal sphincterotomy are variable degrees of gas or stool incontinence. If any incontinence is present after surgery, it’s going to resolve over a short period of time. Patients undergoing sphincterotomy have much improved quality of life as compared to patients with persistent anal fissures. Your colon and rectal operating surgeon can go over each of the potential risks and benefits of sphincterotomy and can decide if this procedure is right for you.