Doctor’s blog

Anal fissures are tears or cuts in the anus and the tears or cuts may extend upward into the anal canal. Anal fissures are common health problem affecting men and women equally. Anal fissure can occur among young and old alike and can be very painful condition which is difficult to tolerate.

Anal fissures occur in the area called anoderm, which is the place where the skin and the mucosa of anal canal join. The anoderm do not have hairs, sweat glands, or sebaceous (oil) glands. Anoderm is richly supplied by large numbers of sensory nerve fibers which are responsible for light touch and pain sensation and cause severe and excruciating pain if cut or torn as seen in anal fissures. As anoderm is devoid of any gland (e.g. sweat gland, sebaceous glands) it may be responsible for easy tearing or cut injury.

Symptoms of anal fissures:

Pain, may be very severe, is the most common symptom of anal fissures. Pain of anal fissure may worsen with bowel movements. The pain of anal fissure may be short duration or may be long lasting. The pain of anal fissures may be severe sometimes and the patients do not want to have a bowel movement and results in constipation. In severe cases there may be impaction of feces. Constipation may cause worsening of the condition, as hard stool (which occurs in case of constipation) can cause further damage/tear/cut of anal fissures.

Some patients of anal fissure may have pain during urinating also. Other symptoms of anal fissure include bleeding (less frequent and small amount of bleeding, but more common among infants), itching, discharge of pus from fissures etc.

Anal fissure is a tear or a cut in the anus, which may extend upwards inside anal canal. Anal fissure is a common health problem and affect many people. It is estimated that approximately 10% (6-15%) of all visits to colorectal surgeon are due to anal fissure, which can help to understand that anal fissure is common health problem. Men and women are equally affected. The common symptoms of anal fissure are pain during passing of stool, bleeding from rectum, especially among infants etc.

Treatment of anal fissure:

The main aim of treatment of anal fissure is to prevent repeated tearing of anoderm and also spasm of anal sphincter. The treatment of anal fissure includes general measures, medical management and surgical treatment.

General measures:

General measures or non surgical measures (drug treatment) are generally successful in case of acute anal fissure, but may not be of much help in case of chronic anal fissures. General measures include intake of easily digestible high fiber diet, use of stool softeners (such as docusate or mineral oil) etc. Sitz baths can reduce spasm.

Pharmacological agents that can be used for treatment of anal fissure are local anesthetics (lidocaine), steroids, muscle relaxants, Botulinum toxin (Botox), calcium channel blocking agents such as nifedipine etc.

Surgical treatment of anal fissure:

Partial lateral internal sphincterotomy is the surgical procedure which is recommended by the American Society of Colon and Rectal Surgeons, for surgical treatment of anal fissure and it is the most preferred surgical method.