Anal fissure: painful but treatable

The lower part of the anal canal is rich in nerve endings. The fissure develops in this sensitive area. The pain causes a reflex spasm of the anal sphincter, and the spasm in turn reduces blood flow to the area and slows the healing of the fissure. In this way a “pain — spasm — failure to heal” cycle develops.

It most often results from hard, large stools, constipation and heavy straining. Long-lasting diarrhea and childbirth trauma can also be a cause. Delaying going to the toilet out of fear of pain makes the stool even harder and the problem worse.

Internal hemorrhoids usually show up as painless bleeding. In an anal fissure, however, the main symptom is severe pain during and after a bowel movement, and there is little blood. These two conditions are often found together. An exact diagnosis can be made only by examination.

• Soften the stool with fiber-rich food and plenty of fluids
• Do not strain, and do not delay going when you feel the urge
• After a bowel movement, wash with warm water and take a warm sitz bath
• Do not use alcohol-based solutions or products that burn

These measures help, but the treatment must be prescribed by a doctor. Only a doctor prescribes topical medications that reduce the spasm.

Most acute fissures heal with conservative treatment. For a chronic fissure — one that lasts longer than 6 weeks, has hardened edges and has a “sentinel pile” next to it — surgical treatment may be required: lateral internal sphincterotomy (LIS) or excision of the fissure (fissurectomy).

Postponing a visit to the doctor because of the pain, as well as self-treatment, can cause the fissure to become chronic. Seeing a doctor early means simpler treatment.