Anal Pain / Anal Fissure Treatment
What is an Anal Fissure?
An anal fissure is a tear in the lining of the anal canal that is associated with anal-rectal pain and sometimes with anal bleeding. Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids.
What Causes an Anal Fissure to Occur?
An anal fissure is most commonly caused by a bout of constipation, or less frequently from an episode of diarrhea. As a result of trauma to the anal canal a small tear develops resulting in significant anal pain associated with bowel movements. This severe anal pain can produce spasm of the anal sphincter muscle, resulting in a decrease in blood flow to the site of the injury, thus impairing healing of the wound. An anal fissure most commonly occurs in either the front or back of the anus, but can occur anywhere around the anal opening. A fissure is a benign condition, but can be associated with Crohn's disease as well as an individual whose immune system is weakened or compromised. Most anal fissures resolve by themselves, but can become a debilitating condition when they fail to heal.
What are Common Anal Fissure Symptoms?
Anal fissure symptoms include anal pain during and after bowel movements, anal muscle spasms, anal rectal bleeding, development of an inflammatory skin tag, and itching. Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain.
ANAL PAIN: Pain is associated with bowel movements, often described as tearing or burning pain. Due to anal muscle spasm, pain can persist from minutes to hours after a bowel movement.
RECTAL BLEEDING: Can vary from a small amount of bright red blood seen only on toilet paper to large amounts seen in the toilet.
ANAL SKIN TAGS: Some anal fissures cause a chronic inflammatory change to the anus that results in the development of an external lump associated with the tear, called a sentinel pile or skin tag,
ITCHING: Can be associated with cyclic healing and re-occurrence of the fissure.
How is an Anal Fissure Treated?
The majority of superficial fissures heal on their own without treatment, while others become chronic issues requiring medical management. Treatments are aimed at interrupting the cyclic pain, by relaxing the anal sphincter muscle spasm, to promote healing of the fissure. Initial treatment involves simple dietary modification with a high fiber diet and increased water consumption, as well as warm water baths ("sitz baths"). Topical prescription medications are used to relax the anal spasm, allow better blood flow to the wound, and promote healing. Additional office-based options for treating anal fissure include Botulinum toxin (Botox®) injection into the anal sphincter, performed as an office procedure. Occasionally symptoms persist despite medical therapy and surgery is needed. Surgical options, discussed and described in the office setting, are performed as a same-day procedure. Your surgeon will discuss with you the risks and benefits of each treatment option.