ANAL FISSURE

July 1, 2022

Written By: Dr. Nusrat Jabeen
(MBBS, MS General Surgery)
General Surgery

Anal Fissure is a tear or a crack in the vertical axis of the squamous lining of the anal canal between the anal verge and the dentate line. An anal fissure may happen when you pass large or hard stools during a bowel movement. Fissures typically cause bleeding and severe pain with bowel movements. Patients with a tight anal sphincter muscle are more likely to develop anal fissures. Fissures are usual in the general population but are sometimes confused with other causes of pain and bleeding.

SYMPTOMS OF ANAL FISSURE:

The following are the most common symptoms and signs of an anal fissure:

  • Pain during bowel movements
  • Anal spasm
  • Constipation
  • Pain after bowel movements that may last up to a few hours
  • Burning and itching that are painful
  • Foul-smelling discharge
  • Bright red blood on the stool after a bowel movement
  • Discomfort when urinating
  • Blood on the outside externals of the stool
  • Frequent urination or inability to urinate
  • Blood on toilet tissues
  • A tiny skin tag or lump on the skin near the anal fissure
  • A visible tear or crack in the anus or anal canal

SIGNS OF ANAL FISSURE:

Triangular cut in the anal canal with or without exposing the anal sphincter. Some people may also have inflamed perianal skin called sentinel pile, which is the sign of chronic anal fissure.

CAUSES OF ANAL FISSURE:

  • Passing large or hard stools
  • Chronic diarrhea
  • Longstanding poor bowel habits
  • Constipation and straining during bowel movements
  • Scarring in the anorectal area
  • Overly tight or spastic anal sphincter muscles
  • Decreased blood flow to the anorectal area
  • Anal intercourse
  • Childbirth
  • HIV
  • Crohn’s disease or other inflammatory bowel diseases
  • Anal cancer
  • Ulcerative colitis
  • Tuberculosis
  • Syphilis
  • Malignancies

FOODS THAT MAY HELP TO HEAL FISSURES:

Here are a few foods that may help if you have fissures:

  1. Papayas
  2. Lemon
  3. Bananas
  4. Oatmeal
  5. Turmeric
  6. Ghee
  7. Milk
  8. Probiotic-rich food like curd
  9. Legumes like beans, chickpeas, lentils, etc

MANAGEMENT OF FISSURES:

The fissures can be managed through medical, surgical, and lifestyle changes.

  1. LIFESTYLE CHANGES: Eat a lot of fiber diet, have good hydration, keep an exercise routine, reduction of weight, and avoidance of constipation can keep the fissures at bay to a great extent.
  2. MEDICAL TREATMENT: The fissures can be medically treated through analgesics, like parastomal, NSAIDs, and anesthetic gels.
  3. SURGICAL TREATMENT: Surgery should be advised when the patient has not responded to medical treatments for at least six months. The surgeries usually done are – anal dilatation, fissurectomy, and lateral sphincterotomy.

TREATMENT FOR ANAL FISSURES:

Anal fissures usually heal within weeks if you keep your stool soft, such as by increasing your intake of fiber and fluids. In addition, soaking in warm water for a few minutes several times a day, especially after bowel movements, can help promote healing and relax the sphincter.

If your signs continue, you’ll likely require further medicine.

NON-SURGICAL TREATMENTS:

Your doctor may suggest:

  • Externally Applied Nitroglycerin (Rectiv) to assist boost blood flow to the fissure, promote healing, and help relax the anal sphincter. Nitroglycerin is considered the medical treatment of choice when other conservative measures fail. Side effects may include headaches, which can be intense.
  • Topical Anesthetic Creams like lidocaine hydrochloride (Xylocaine) may help relieve the pain.
  • Botulinum Toxin Type A (Botox) Injection paralyzes the anal sphincter muscle and relaxes cramps.
  • Blood Pressure Medications, such as diltiazem (Cardizem) or oral nifedipine (Procardia), can aid soothe the anal sphincter. These medicines may be applied externally or taken by mouth and used when nitroglycerin is useless or causes significant side effects.

SURGERY FOR FISSURES:

If you have a chronic anal fissure resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a Lateral Internal Sphincterotomy (LIS), which involves cutting a tiny portion of the anal sphincter muscle to reduce pain and spasms and promote recovery. The other preferred surgeries are anal dilatation and fissurectomy.

Studies have found that surgery is much more effective for chronic fissures than any medical treatment. However, surgery has a slight risk of generating incontinence.

FISSURE TREATMENT IN BAHRAIN:

Al Hilal Hospital is the largest and fastest-growing chain of private healthcare providers in Bahrain, with five branches. Al Hilal Healthcare Group is committed to providing high-quality healthcare services at an affordable price to the people of Bahrain through a combination of superior medical technology and excellent clinical services. Its vision is to be the largest healthcare service provider in the region by catering to the needy at the most affordable rates.

Al Hilal Healthcare Group now offers advanced surgical solutions for major surgeries. We now introduce Laparoscopic and Laser Surgeries as well. In addition, Al Hilal has specialist surgeons who do the Lateral Internal Sphincterotomy (LIS), anal dilatation, and fissurectomy successfully.

FISSURE SPECIALIST IN BAHRAIN:

Al Hilal Healthcare group is equipped with high surgical excellence and the best and most experienced surgeons. Al Hilal provides all these surgeries at an affordable price to the patients. We also offer the utmost care before, during, and after the surgery. We have General Surgeons who are well-experienced in Lateral Internal Sphincterotomy (LIS), anal dilatation and fissurectomy