Service
Anal fissure: symptoms and treatment
- Section
- Services
- Specialist
- Op. Dr. Dilara Hasanova
- Clinic
- Modern Hospital, Baku
- The doctor's practice — examinations and treatments Dr. Hasanova performs herself
- General information — educational text about diseases and methods
What is an anal fissure?
Short answer
An anal fissure is a small but very painful tear in the thin skin (anoderm) that lines the lower part of the anal canal. It is often located at the back midline. The main signs are a cutting, burning pain during and after a bowel movement that lasts for minutes, sometimes for hours, and bright red blood on the toilet paper.
Acute and chronic fissure
- Acute fissure — a recently formed fissure with soft edges. With proper treatment it often heals without surgery.
- Chronic fissure — lasts longer than 6 weeks. Its edges harden, and a “sentinel lump” (sentinel pile) and an anal papilla may enlarge next to the fissure. In such cases medication alone may not be enough.
The pain causes spasm of the anal sphincter. The spasm reduces blood flow to the area and makes it harder for the fissure to heal. This creates a “pain — spasm — non-healing” cycle.
“Pain — spasm — non-healing” cycle
- Painduring and after defecation
- Spasmreflex spasm of the anal sphincter
- Non-healingblood flow drops, no healing
Symptoms
- Severe, cutting pain during a bowel movement
- Burning and pain that continue after using the toilet
- Bright red blood on the toilet paper or on the surface of the stool
- Putting off going to the toilet out of fear of pain, which makes constipation worse
- A small skin tag at the edge of the anus in a chronic fissure
Causes
- Constipation, hard and large stools
- Prolonged diarrhea
- Injury during childbirth
- Mechanical injury to the anal area
- Increased tone (spasm) of the anal sphincter
If the fissure is in an atypical location (on the sides), if there are several, or if it does not heal despite treatment, Crohn's disease, infections and other causes must be ruled out with further examination.
Anal fissure and hemorrhoids: what is the difference?
| Anal fissure | Hemorrhoids | |
|---|---|---|
| Pain | Severe pain during and after a bowel movement | Internal hemorrhoids usually cause no pain |
| Blood | A small amount, on the toilet paper | As drops or spots, sometimes a large amount |
| Lumps | A small skin tag in a chronic fissure | Lumps that protrude when straining |
| Treatment | Reducing sphincter spasm, LIS when needed | Depending on the grade: medication, office procedures, surgery |
Both conditions are often found together. An accurate diagnosis is made by examination.
Diagnosis
In most cases the fissure can be seen on careful inspection of the anus. If the pain is severe, an instrument examination is performed with a numbing gel and with caution, or is postponed until the acute phase has passed. When needed, video proctoscopy is performed.
Treatment
General information
- Conservative treatment (first step): a fiber-rich diet and plenty of fluids, stool softeners, resolving constipation, warm sitz baths, pain-relieving ointments and topical preparations that reduce sphincter spasm (as prescribed by a doctor). Most acute fissures heal this way.
- Surgical treatment (for chronic fissure):
- Lateral internal sphincterotomy (LIS) — cutting a small part of the internal sphincter to relieve the spasm. It is a widely used method for treating chronic fissure. In rare cases, the ability to hold gas or stool may be impaired. Read more: Lateral internal sphincterotomy (LIS)
- Fissurectomy — excision of the hardened edges of the fissure, the sentinel lump and the enlarged papilla.
The doctor's practice
Examinations and treatments Dr. Hasanova performs herself
- In acute anal fissure, she carries out courses of conservative treatment.
- In chronic fissure, she performs operations to excise the fissure (fissurectomy) and lateral internal sphincterotomy (LIS).
- When an anal fissure occurs together with hemorrhoids or an anal polyp, she often combines the operations in one session.
Frequently asked questions
Will an anal fissure heal on its own?
An acute fissure often heals within a few weeks once constipation is resolved and with proper treatment. A chronic fissure, which lasts longer than 6 weeks, usually does not go away on its own and requires surgical treatment if it does not respond to medication.
Is the examination very painful with an anal fissure?
A special numbing gel is used during the examination. The fissure itself is often visible on gentle inspection. If the pain is very severe, the doctor limits the instrument examination or postpones it.
Can alcohol or a caustic home remedy be applied to the anal area?
No. Alcohol-based solutions and caustic agents damage the mucous membrane and increase pain and inflammation. The cause of itching or pain must be determined by a doctor, who then prescribes appropriate treatment.
Is the ability to hold stool impaired after LIS surgery?
In most patients it is not impaired. In rare cases there may be temporary or persistent difficulty holding gas or liquid stool. This risk is discussed with the doctor before the operation. In patients with risk factors, alternative methods may be chosen.