Fissure

What is a fissure?

An anal fissure is a cut or a tear in the thin, delicate lining of the anus.

The tear often exposes the muscle around the anus, called the anal sphincter. The damage can cause that muscle to spasm, which can pull apart the edges of the fissure even more. The spasms can cause pain and slow down the healing. Bowel movements can also keep the fissures from getting better.

What are the symptoms?

Typically patients present with severe pain during or after bowel movements that can last up to several hours. There can be bright red blood on the stool or toilet paper after a bowel movement. There is sometimes a visible crack in the skin around the anus or a small lump or skin tag on the skin near the anal fissure.

What are the treatment options?

Most of the cases are usually treated conservatively by application of local acting agents along with stool softeners and dietary modifications. Patients with excruciating pain or with large amount of bleeding per rectum need surgery. Surgical approaches include conventional open lateral internal sphincterotomy which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Surgery may also be performed using a laser probe reducing the pain to a considerable extent along with a shorter post surgery recovery period.