WHAT IS AN ANAL FISSURE?
The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). An anal fissure is a small rip or tear in the lining of the anal canal. Fissures are common, but are often confused with other anal conditions, such as haemorrhoids.
WHAT ARE THE SYMPTOMS OF ANAL FISSURE?
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)
WHAT CAUSES ANAL FISSURE?
Fissures are 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 a hard, dry bowel movement or loose, frequent bowel movements. Patients with a tight anal sphincter muscle are more likely to develop anal fissures. Less common causes of fissures include inflammatory bowel disease, anal infections, trauma or tumours. Chronic fissures often have a small external lump associated with the tear called a sentinel pile or skin tag.
HOW CAN FISSURE BE TREATED?
NONSURGICAL TREATMENT
Treatment includes:
- A high-fibre diet and over-the-counter fibre supplements (25-35 grams of fibre/day) 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 anal sphincter muscles).
- Medications to relax the anal sphincter muscles, which helps the healing process.
SURGICAL TREATMENT
Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Surgical options include Botulinum toxin (Botox®) injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy).
WILL THE PROBLEM RETURN?
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 tumours can cause symptoms similar to anal fissures. If a fissure does not improve with treatment, it is important to evaluate for other possible conditions.
HOW LONG DOES THE HEALING PROCESS TAKE AFTER SURGERY?
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.
CAN ANAL FISSURES LEAD TO COLON CANCER?
Anal fissures do not increase the risk of colon cancer nor cause it. However, conditions that are more serious can cause similar symptoms. Even when a fissure has healed completely, your colon and rectal surgeon may request other tests. A colonoscopy may be done to rule out other causes of rectal bleeding.
WHO IS A COLON & RECTAL SURGEON?
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions.
