An anal fissure is a tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements
Anal fissures are very common and can affect people of any age. Some people with anal fissures may need conservative treatment or occasionally surgery in case of long-standing fissure not responding to non-surgical treatment.
Symptoms
Signs and symptoms of an anal fissure include:
· Pain, sometimes severe, during bowel movements
· Pain after bowel movements that can last up to several hours
· Bright red blood on the stool or toilet paper after a bowel movement
· A visible crack in the skin around the anus
· A small lump or skin tag on the skin near the anal fissure, specially seen in case of long-standing anal fissure.
Risk factors
Factors that may increase your risk of developing an anal fissure include:
· Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. This is considered to be the most common cause.
· Childbirth. Anal fissures are more common in women after they give birth.
· Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.
· Anal intercourse.
Complications
Complications of anal fissure can include:
· Failure to heal. An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
· Recurrence. Once you've experienced an anal fissure, you are prone to having another one.
· A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.
Prevention
One may prevent an anal fissure by taking measures to prevent constipation or diarrhea. Eat high-fiber foods, drink fluids and exercise regularly to keep from having to strain during bowel movements.
Treatment
Anal fissures often heal within a few weeks if one take steps to keep stool soft, such as increasing intake of fiber and fluids. Sitz bath with luke- warm water 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.
In case there is no relief with non- surgical treatment and anal fissure fails to heal then surgery is required.
Surgery
Surgery for anal fissure is known as lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing.
Now days laser internal sphincterotomy is done for chronic /non healing anal fissure. There is not cut made in the skin and the procedure causes literally no bleeding and no or mild discomfort after the procedure.
Studies have found that for chronic fissure, surgery is much more effective than any medical treatment.
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