Posted By : Dr. Sanjay Dalmia MS FRCS FRCS
What is Anal Fissure? An anal fissure is a crack in the lining of the anal canal. This can occur at any age, but usually occurs in young adults. Fissures may be caused by constipation and passage of hard stool, or diarrhoea and passage of frequent stool. However, the majority seem to develop without any particular cause. Some defect in the blood supply to the area has has been implicated as the main cause. The symptoms of a fissure are pain, especially when passing a bowel motion, and some bleeding.
How can a fissure be treated? Less than 30 per cent of fissures heal either by themselves or with non-operative treatment, including application of special medicated cream, use of stool softeners, avoidance of constipation. Fissures that do not respond to these methods will require an operation. Fissures of short duration (Acute) are more likely to be treated by medicines. Long standing fissures (Chronic) are more likely to need surgery. Conservative treatment Commonly an ointment 0.2% GTN or Diltiazem has been used.
What does the surgery involve? The commonest operation for this condition is lateral anal sphincterotomy. This involves cutting a portion of one of the anal muscles which helps the fissure to heal by preventing pain and spasm and which improves the blood supply to the skin. Cutting this muscle (Internal sphincter) rarely interferes with the ability to control bowel movements and can often be performed as day case. Anoplasty is also used in some cases. Recently botox injection in the anus have been used successfully but are not widely available. Anal stretch is not used these days.
Is there any risk of surgery? Minor and temporary weakness in control of stool is not uncommon. Any significant risk of incontinence is rare.