Anal Fissure

What is anal fissure?

Anal fissure [fissure-in-ano] is a small tear (cut) in the lining of the anus which is the last portion of the large intestine.  Anal fissure is common and can occur from infancy to old age.  It affects both men and women.  It is often confused with hemorrhoids.  Diagnosing anal fissure correctly is a very important first step for its proper treatment.

 

What causes anal fissure?

Anal fissure is usually caused by trauma with stretching and scratching the lining of the anus.  This can be due to hard bowel movements, diarrhea or frequent bowel movements.  Less common causes include cancer, infections, inflammatory bowel disease such as Crohn’s disease, and radiation.

 

What are the symptoms of anal fissure?

Anal fissure causes sharp pain and bleeding.  The pain can be very severe, typically occurs with the passage of stool, and can last from a few minutes to several hours.  Bleeding occurs when the cut is fresh and can subside after a period of time in some patients.  The bleeding tends to be bright red blood in the toilet bowl or on toilet paper upon wiping.  Itching and burning is present on occasions.  A skin tag or a small lump is noticeable in some patients.

 

How is anal fissure treated?

Most fissures heal spontaneously within a few days without the need of treatment.   When a fissure persists, it is initially treated medically with a combination of remedies:

• Warm Sitz Bath 2 to 3 times a day. This is especially helpful after bowel movements to clean the area and relax the anal sphincter muscle
• Adequate water intake with at least 8 glasses of water per day to prevent hard stools
• High Fiber Food and Fiber Supplements
• In case of severe constipation, the use of Laxatives and Stool Softeners

• Ointment for pain, medications to relax the sphincter muscle and heal the fissure. Dr. Maher Abbas will prescribe the best ointment for you in the clinic.  Even if the pain subsides, continue to use the prescribed ointment until you see Dr. Maher Abbas for a follow-up visit.  Stopping the ointment will lead to non-healing.

   

If a fissure does not heal with medical treatment, a surgical procedure is very beneficial.  The goal of surgery is to release the muscle spasm in order to heal the fissure and rid of the pain.  Several procedures are provided by Dr. Maher Abbas and include:

• Anal dilation
• Lateral internal sphincterotomy [a procedure to divide a small portion of the internal sphincter muscle]. This is the procedure with the highest success rate
• Minimally Invasive Procedures for Fissure. These procedures include:
  • Medication injection into the sphincter muscle with removal of the fissure
  • Laser based fissure procedures

Dr. Maher Abbas will recommend the procedure that is best suited for your case.  He will explain the procedure, its success rate, potential risks, and the recovery period.   Most procedures are performed on an outpatient basis [day case] or with an overnight hospital stay.  Most patients can return to work and go back to daily activities within a few days of the procedure.  Complete healing after both medical and surgical treatments can take 6 to 10 weeks. Even when the pain and bleeding improve, it is important to maintain good bowel habits and eat a high-fiber diet to allow for full healing and prevent recurrence.

 

What happens if a fissure is left untreated?

Anal fissure is a nuisance that negatively impacts a person’s quality of life.  It is usually not dangerous and does not cause cancer.  On rare occasions, a fissure can become infected and turn into an Anal Abscess and/or Anal Fistula. Anal fissure should be treated to avoid long-term suffering.

 

Why is important to seek expert care with a colorectal surgeon and proctologist?

The anal area is a delicate part of the body.  It is important to seek care to heal and to exclude other more serious causes of anal pain.  The expertise of the doctor is critical in order to ensure the best result and minimize the risk of relapse, non-healing, infection, and weakness of the muscle. Furthermore, some patients need additional work-up such as Flexible Sigmoidoscopy or Colonoscopy to exclude other causes of anal fissure.

Dr. Maher Abbas is an expert in the surgical and non-surgical treatment of diseases of the colon, rectum and anus.  With over a 30 years career in the USA, he has completed advanced surgical training and is American Board-certified in Colon and Rectal Surgery.   Dr. Maher Abbas is a Fellow of the American Society of Colon and Rectal Surgeons.

If you would like to schedule a consultation with Dr. Maher Abbas to discuss your case, Click Here.