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Anal Fissures

An anal fissure or rectal fissure is a break or tear in the skin of the anal canal (a short tube surrounded by muscle at the end of your rectum).  Anal fissures are associated with bright red rectal bleeding and can be a source of severe rectal pain and discomfort.  Patients will often experience severe unexplainable rectal spasms that can last from minutes to hours after a bowel movement. Fissures are common, but due to the symptoms being similar, it is often confused with other anal conditions such as hemorrhoids, fistulas, and abscesses.

There are two types of anal fissures, acute and chronic.  An acute anal fissure will cause pain after defection while a chronic anal fissure may not be as painful.  Most anal fissures are caused by stretching of the anal lining beyond its capability which results in internal tearing. In adults, anal fissures may be the result of constipation, passing of large, hard stools, anal intercourse, and by prolonged diarrhea. In older adults, anal fissures may be caused by decreased blood flow to the area.

 

 

 

 

 

 

 

 

 

Fissures are usually caused by trauma to the inner lining of the anus from a bowel movement or other stretching of the anal canal. This can be due to constipation, passing of large hard stools, anal intercourse, prolonged diarrhea, or frequent bowel movements.  In some patients, an anal fissure may be caused by a decrease of blood flow to the area.  Patients with a tight anal sphincter muscle are more likely to develop anal fissures. 

 

 

Anal fissures typically cause a sharp pain that starts with the passage of stool. This pain may last several minutes to a few hours. As a result, many patients may try not to have bowel movements to prevent the pain.  Other symptoms include:

·  Bright red blood on the stool or toilet paper after a bowel movement

·  A small lump or skin tag on the skin near the anal fissure (more common when chronic or having been present for greater than 6 weeks)

 

 

 

 

 

The following are ways to prevent anal fissures from occurring in adults.

 

  • Avoid straining when using the toilet. 

  • Treat and prevent constipation by eating foods rich in dietary fiber, drinking sufficient water and occasionally using a stool softener.

  • Use of soft toilet paper, sanitary wipe or cleaning with water may help alleviate some of the painful symptoms.

 

It is important that symptoms be evaluated by a colon-rectal surgeon before you try self-treatment.  A colon-rectal surgeon will perform a thorough examination and recommend treatment.  The physicians at Connecticut Colon & Rectal Surgery, LLC develop an individualized treatment plan based on the symptoms you are experiencing and your physical exam.  If your symptoms are mild, a nonsurgical approach may be advised.  However, if your symptoms are severe, surgical intervention may be recommended.  

Non-Surgical Treatment: You do not have to live with the pain, treatment for anal fissures is highly effective.  Your physician will properly diagnose an anal fissure, and work with you to resolve your symptoms by discussing the benefits and side effects of treatments.

Treatment includes: 

  • A high-fiber diet and over-the-counter fiber supplements to make stools soft, formed, and bulky.

  • Over-the-counter stool softeners to make stools easier to pass.

  • Drinking more water to help prevent hard stools and aid in healing.

  • Warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day (especially after bowel movements to soothe the area and help relax the anal sphincter muscles).  This it thought to help the healing process.

  • Medications, such as lidocaine, that can be applied to the skin around the anus for pain relief. 

  • Compound medications such as nifedipine or nitroglycerin ointment to relax the anal sphincter muscles which helps the healing process.

*Narcotic pain medications are avoided because they can cause constipation which could make the situation worse. 

Surgical Treatment: Although most anal fissures do not require surgery, chronic fissures are harder to treat.  If a patient is unresponsive to the conservative treatment options, surgery may be recommended.  The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Surgical options may include a Botox injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Your colon and rectal surgeon will find the best treatment for you and discuss the risks of surgery. Both types of surgery are typically done as same-day outpatient procedures. 

 

Lateral Internal Sphincterotomy is an operation to treat an anal fissure, a tear in the opening of the anus that can cause pain, itching, and bleeding.  During this operation the surgeon starts by carefully inspecting the anal canal with a short, rigid anoscope.  Once the anal fissure is identified, the operation may continue via an open approach.  In an open approach, a small incision is made in the left or right side of the anal skin to expose the internal sphincter muscle fibers.  The surgeon will then lift up the internal anal sphincter muscle and divide it using a knife of thermal cautery.  Cutting the muscle relaxes the pressure in the anus and allows the fissure to heal.  The surgery itself usually takes less than 30 minutes and is the most effective method for treating an anal fissure.

 

 

Most patients can return to work and go back to daily activities a few days after surgery. Complete healing after both medical and surgical treatments can take 6 to 10 weeks. Even when the pain and bleeding lessen, it is important to maintain good bowel habits and eat a high-fiber diet. Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing.

 

Sphincterotomy is successful in more than 90% of patients. Although uncommon, this procedure may affect the patient’s ability to fully control gas or bowel movements.

Fissures often come back. A fully healed fissure can come back after a hard bowel movement or trauma. Medical problems such as inflammatory bowel disease (Crohn’s disease), infections, or anal tumors can cause symptoms like anal fissures. If a fissure does not improve with treatment, it is important to be evaluated for other possible conditions. 

 

 

To schedule an appointment, please call our office at (860) 826-3880 or request an appointment online. If appropriate and availability allows, a consultation appointment will be scheduled for you to be seen by one of our experienced physicians, generally, within a two-week timeframe of contacting the office.  Procedures are generally scheduled shortly thereafter.

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What Causes Anal Fissures?

What are the Symptoms of Anal Fissures?

How can Anal Fissures be Prevented from Occurring?

How are Anal Fissures Treated?

Post-Treatment Prognosis

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