What Is an Anal Fissure
An anal fissure is a tear in the anal canal causing great pain during and after bowel movement. The formation of an anal fissure starts from an episode of severe constipation. Hard stools rub against the anal canal during defecation, resulting in a tear in the tissue. The tear then causes internal anal sphincter muscle spasm, which makes defecation harder and requires more force and effort, further tearing the tissue. This leads to a vicious cycle that makes the recovery of the tissue difficult.
Anal fissures can be classified into two types:
Acute Anal Fissures
– These are recent tears in the anal mucosa, typically less than six weeks old.Chronic Anal Fissures
– These are longer-lasting and deeper tears that have persisted beyond six weeks.
Determining if the tear is an acute or chronic anal fissure is important, as chronic fissures can lead to more serious complications and require specialised treatment or surgery.
What Are the Signs and Symptoms of an Anal Fissure?
- A sharp, severe pain during and after defecation
- Bright red blood on paper after cleaning
- A skin tag or small lump of skin near the tear
- A crack in the skin around the anus
What Causes Anal Fissures?
Fissures are usually caused by trauma to the lining of the anus or the anal canal. This often happens when a person has:
- Constipation
- Severe Diarrhoea
- Anal Injuries
- Given Birth
Potential Complications of
Anal Fissures
- Failure to Heal – If an acute fissure fails to heal even after six to eight weeks, it is considered a chronic fissure which will require further and more complex treatment.
- Recurrence – There is a possibility of recurrence even after an anal fissure heals, leading to a cycle of discomfort and repeated treatments.
- Muscle Damage – Chronic anal fissures may lead to spasms and damage to the surrounding internal anal sphincter muscle.
How Is an Anal Fissure
Diagnosed?
Fissures are usually caused by trauma to the lining of the anus or the anal canal. This often happens when a person has:
- Physical Exam – The doctor will gently examine the anal area to identify visible tears, skin tags, or signs of chronic fissures around the patient’s anus and rectum. Usually, this is all that is needed to diagnose an anal fissure.
- Additional Tests – In some cases, however,
the doctor may need to perform further tests to confirm the diagnosis, or to
find out if there is an underlying condition. These include:
- Anoscopy: This is a tube-like device that will be inserted into the anus to allow the doctor to see the rectum and anus clearly.
- Flexible Sigmoidoscopy: This is used to examine the lower part of the colon and the rectum. This test may be done if the patient is younger than 45 and has no risk factors for intestinal diseases or colon cancer.
- Colonoscopy: This procedure uses a flexible scope to examine the entire colon and large intestine. Colonoscopy is recommended for patients aged 45 and above, who have risk factors for colon cancer or have symptoms of other conditions.
Treatment Options for Anal Fissure
Topical Ointment (Nitrates)
The application of nitrates helps to relax the anal sphincter and relieve the pain during defecation. However, it can cause significant headaches in some patients.
Botox Injection
This is a simple out-patient procedure that involves the injection of botulium toxin (BOTOX) into the anal sphincter helps to relax the anus and allow healing of the anal fissure. The effect of BOTOX injection is almost immediate and patient can experience relief of pain very soon after the procedure.
Anal Sphincterotomy
This colorectal surgery involves the cutting of the lowest fibre of internal anal sphincter to permanently relax the anal sphincter the level of the fissure. This is one the most effect procedure to relieve pain and muscle spasm in very long-standing anal fissure.
Post-Treatment Care and
Recovery
Most acute fissures respond well to medication and lifestyle adjustments. Chronic fissures, however, may require more specialised treatment.
Other recommendations to support recovery and lower risk of recurrence include:
- Using Stool Softeners – Using stool softeners helps make bowel movement easier to prevent straining and further irritation of the anal fissure.
- Sitting in a Warm Sitz Bath – Sitting in a few inches of warm water helps reduce pain, promote blood flow and encourage healing of the fissure.
- Using Moist Tissues – Moist tissues or wipes provide gentler cleaning of the anal area than dry tissues.
- Taking Muscle Relaxants – When taken as prescribed, these can help reduce muscle spasms.
- Visiting the Bathroom Promptly – Delaying bowel movements can lead to constipation and straining, which can worsen or cause fissures.
- Avoiding Hard-to-Digest Food – Foods that are difficult to digest can lead to constipation or hard stools, which can worsen anal fissures.
- Exercising Regularly – It helps maintain healthy bowel function and prevents constipation.
- Limiting Time on the Toilet – Spending excessive time on the toilet can increase pressure on the anal area and contribute to the formation or worsening of fissures.
- Dietary and Lifestyle Changes – Incorporating a high-fibre diet and proper hydration can help maintain smooth bowel movements and prevent anal fissures.
| : khngsurgery@gmail.com | |
| Phone | : +65 6475 5512 |
| Whatsapp / SMS | : +65 8228 5578 |
| Fax | : +65 6255 8660 |