Fissures – Symptoms
Signs and symptoms of fissures include –
- Severe pain while passing stool that lasts for several hours
- Bleeding during bowel movement
- A visible crack in the skin around the anal region
- A small lump on the skin near the anal fissure
Fissures – Causes
Fissures can occur at any age. However they are more common in middle-aged people and infants. Common causes of anal fissure include:
- Irregular bowel habits
- Constipation and straining while passing stool
- Anal injuries in accidents
- Anal intercourse
- Straining during childbirth
Less common causes of anal fissure include:
- Anal cancer
- HIV/ Tuberculosis/ Syphilis/ Herpes infection
Fissures – Diagnosis
- Physical Exam – Visual inspection of the anal region is done to check for tear. Usually this test alone is enough to diagnose an anal fissure. But if there is suspicion of any underlying condition, further testing may be ordered.
- Anoscopy – A tubular device called anoscope, is inserted into the anus to help the doctor examine the rectum and anus.
- Flexible sigmoidoscopy – A flexible tube is inserted into the anus to inspect the lower portion of the colon. This test may be done for those under the age of 50, and with no risk factors for intestinal diseases or colon cancer.
- Colonoscopy – Similar to sigmoidoscopy, a tube is inserted into the rectum to examine the entire colon. This test may be done for those older than age 50 or with risk factors for colon cancer or other symptoms such as abdominal pain or diarrhea.
Fissures – Treatment
An anal fissure often heals by itself within a few weeks if you increase your fiber and fluid intake. Soaking the anal region in warm water for 10-20 minutes several times a day, can help promote healing. If symptoms persist, you will require further treatment:
Non-surgical Treatment –
- You may be prescribed medication that relaxes the sphincter muscle and helps healing by increasing blood flow to the fissure site.
- Your doctor may recommend topical anesthetic creams to relieve pain and spasms.
Surgical Treatment –
For chronic fissures (those which last more than 8 weeks), surgery is most effective. The surgery performed for treating anal fissure is called Lateral Internal Sphincterotomy (LIS). In LIS, a small portion of the anal sphincter muscle is cut to reduce spasm and pain, and promote healing.
Fissures – Risks & Complications
Complications of anal fissure can include:
- Recurrence – Once you develop anal fissure, you are at a higher risk of having one again.
- A tear extending to surrounding muscles – An anal fissure may extend into the ring of muscle that holds the anus closed thus delaying the healing process of the fissure.
Some complications after fissure surgery include bleeding, lack of voluntary control on stool and gas, infection or abscess formation near the wound, and development of anal fistula (very rare).
Fissures – Pre Op Care
- Inform your doctor about ongoing medication and supplements.
- You may be given enema to clear bowels before the surgery.
Fissures – Post Op Care
- Take the prescribed painkillers and laxatives to prevent constipation.
- Drink plenty of fluids and consume a high-fiber diet to prevent recurrence of the fissure.
- Take fiber supplements if directed by your doctor.
- Sit for 15-20 minutes in warm water multiple times a day, especially after bowel movement.
- Keep the wound area of sphincterotomy, clean and dry to help it heal and prevent infection.
- Avoid strenuous activity for one week.