SYMPTOMS OF AN ANAL FISSURES
The typical symptoms of an anal fissure include severe pain during, and especially after, a bowel movement, lasting from several minutes to a few hours. Patients may also notice bright red blood from the anus that can be seen on the toilet paper or on the stool. Between bowel movements, patients with anal fissures are often relatively symptom-free. Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain.
Fissures are usually caused by trauma to the inner lining of the anus. Patients with tight anal sphincter muscles (i.e., increased muscle tone) are more prone to developing anal fissures. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. Following a bowel movement, severe anal pain can produce spasm of the anal sphincter muscle, resulting in a decrease in blood flow to the site of the injury, thus impairing healing of the wound. The next bowel movement results in more pain, anal spasm, decreased blood flow to the area, and the cycle continues. Treatments are aimed at interrupting this cycle by relaxing the anal sphincter muscle to promote healing of the fissure.
TREATMENT OF ANAL FISSURES
The majority of anal fissures do not require surgery. The most common treatment for an acute anal fissure is a high-fiber diet and utilization of over-the-counter fiber supplements (totaling 25-35 grams of fiber/day). Stool softeners and increasing water intake may be necessary to promote soft bowel movements. Topical anesthetics for pain and warm tub baths (sitz baths) for 10-20 minutes several times a day, especially after bowel movements, are soothing and promote relaxation of the anal muscles.
Other medications (nitroglycerin, nifedipine, or diltiazem) can help relax the muscles are not recommended for anal fissures, as they promote constipation.
SURGERY FOR ANAL FISSURES
Surgical treatment for anal fissures divides of a portion of the internal anal sphincter (lateral internal sphincterotomy). The goal of surgery is to relax the anal sphincter, thereby decreasing anal pain and spasm, allowing the fissure to heal. All surgeries carry some risk, and a sphincterotomy can rarely interfere with one’s ability to control gas and stool. Dr. Itriago will discuss these risks with you to determine the appropriate treatment.
Healing can take up to approximately 6-10 weeks. However, acute pain after surgery often disappears after a few days. Most patients can return to work and resume daily activities in a few short days after the surgery.
RECCURANCE OF ANAL FISSURES
Fissures can recur easily, and it's quite common for a fully healed fissure to come back after a hard bowel movement or other trauma. Even when the pain and bleeding have subsided, it's important to keep with a high-fiber diet. If the problem returns without an obvious cause, you should talk to your doctor.
Persistent hard or loose bowel movements, scarring, or spasm of the internal anal muscle all contribute to delayed healing. Other medical problems such as inflammatory bowel disease, infections, or anal tumors can cause similar symptoms to fissures. Patients suffering from persistent anal pain should receive a colonoscopy to exclude other conditions and symptoms.