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What is an anal fissure?
An anal fissure also called an anal ulcer, is a small tear in the thin, moist tissue (mucosa) that lines the anus. This occurs when you pass hard or big stools during a bowel movement. Painful bowel movements or bloody stools are common symptoms of anal fissures. Spasming of the ring muscle at the end of the patient’s anus (anal sphincter) may also occur due to this condition.
Anal fissures are especially prevalent in infants, although they can happen to anyone and at any age. Sometimes anal fissures heal on their own in 4-6 weeks. However, simple therapies, such as increased fiber intake or sitz baths, can help cure most anal fissures. Anal fissures may necessitate medication or, in rare cases, surgery.
When do you need anal fissure treatment?
The patient might require medical consultation if the following symptoms appear:
- Severe pain during bowel movement
- Pain that lasts for several hours following bowel movements
- Bright crimson blood on the stool or toilet paper after a bowel movement
- The skin around the anus has an obvious break in it.
- A tiny lump of skin tag that appears near the anal fissure
If you take precautions that enable your stool to remain soft, such as increasing your fiber and fluid intake, anal fissures can heal in a few weeks. Soaking the affected area for 10 to 20 minutes in warm water, especially after bowel motions, can help relax the sphincter and encourage faster healing.
What are the different types of surgical procedures for anal fissure repair?
Physicians may suggest surgical treatments to treat anal fissures when nonsurgical methods fail to provide relief.
The most common surgical procedure that’s used to treat persistent anal fissures is called sphincterotomy. Here are some of the common procedures carried out by surgeons to treat this condition:
- Lateral internal sphincterotomy - This procedure involves making a small incision in the anal sphincter. It helps alleviate the pressure and tension in the sphincter and is usually performed under general anesthesia. With a short, rigid anoscope, the surgeon thoroughly inspects the anal canal. Most patients are discharged on the same day of the procedure.
- Open approach – A small incision is made on the left or right side of the anal skin to expose the internal sphincter muscle fibers in the open approach. The internal anal sphincter muscle is lifted and divided with a knife or thermal cautery by the surgeon. The pressure in the anus is relieved by cutting the muscle, allowing the fissure to heal.
- Closed approach -The closed approach is identical to the open approach. However, the surgeon will feel for a groove between the internal and external sphincter muscles instead of making a skin incision. After locating the groove, a scalpel is put into the space and carefully turned toward the internal sphincter, dividing the muscle.
- Fissurectomy - This procedure involves removing the anal fissure, along with the skin and tissues surrounding the fissure. Similar to sphincterotomy, this procedure can be performed as outpatient surgery, but the surgical site will require 4-6 weeks to heal; hence patients are advised to stay at home post-surgery during the healing cycle.
What is the risk associated with an anal fissure?
Anal fissures carry the following risks:
- Constipation - Tearing is more likely when you strain during bowel motions or pass firm stools.
- Crohn's disease - It is a chronic inflammatory bowel illness. Irritable bowel disease produces persistent inflammation of the intestinal tract, rendering the anal canal lining more sensitive to tearing.
- For the first week after surgery, avoid physically intense activities
- For the first few days, take sitz baths (sit in warm water for 15-20 minutes) three times a day and after each bowel movement
- If you experience any bleeding, discharge, or itching during your healing, do not be concerned
- Maintain a balanced diet that includes plenty of fresh fruits and vegetables
- Drink 6-8 glasses of water a day
- Call your doctor if your body temperature rises to 101 or above
What is the post-operative care for fissure repair?
Post-surgery, it is normal to feel mild to moderate pain around the rectal area. Constipation, trouble urinating, and perhaps rectal bleeding are common temporary problems faced by patients.
Here are some general tips provided to patients as part of their post-operative care:
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