Introduction
The word 'fissure' means a 'tear'. An anal fissure is where the mucosa (the lining of the anus) becomes torn. It predominantly affects adults, more so females, aged between 15 and 40.
Symptoms
- Severe pain in the anus / anal area during a bowel movement and afterwards.
- Bleeding from the anus.
- Formation of a (sometimes swollen) skin tag on the outside of the anus.
Causes
The main causes are constipation or at times, diarrhea. Other causes include trauma and other medical conditions such as Crohn's disease and anal cancer. Anal fissures are common during and after pregnancy.
Tests & Diagnosis
The two primary methods of diagnosing an anal fissure are…
- Digital Rectal Examination – this is where a doctor uses a gloved and lubricated finger to examine the rectum.
- Anoscopy – a small device in the shape of a tube equipped with a small light which is inserted into the anus to make a visual examination.
In some cases, both of these methods may be too painful for the patient – in which case a standard visual examination is conducted.
Treatment
Although an anal fissure may heal of its own accord, a large number require some form of medical treatment. In general terms, the smaller the fissure and the less time it has been present, the more likely it is to be able to heal on its own.
Treatment of anal fissures include:
- Softening the stools with laxatives, if constipation is present.
- Topical creams to relax the sphincter muscle, which is in spasm.
Surgery may be required if these fail, which may involve an injection of Botox into the sphincter muscle, or cutting a small portion of sphincter muscle.
