Fissure Treatment
Signs and Symptoms:
- Pain, sometimes severe, during bowel movements
- Pain after bowel movements that can last up to several hours
- Bright red blood on the stool or toilet paper after a bowel movement
- A visible crack in the skin around the anus
- A small lump or skin tag on the skin near the anal fissure
Causes
- Passing large or hard stools
- Constipation and straining during bowel movements
- Chronic diarrhea
- Anal intercourse
- Childbirth
Complications
Complications of anal fissure can include:
Failure to heal
- An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
Recurrence
- Once you've experienced an anal fissure, you are prone to having another one.
A tear that extends to surrounding muscles.
- An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.
Diagnosis
- Your doctor will likely ask about your medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually this exam is all that's needed to diagnose an anal fissure.
- An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear, and may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.
Treatment
Nonsurgical treatment
- Externally applied nitroglycerin to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe.
- Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief.
- Botulinum toxin type A (Botox) injection , to paralyze the anal sphincter muscle and relax spasms.
- oral nifedipine or diltiazem can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects.
Surgery
- If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing.
- Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.