Anal Fissures

What causes an anal fissure?

Some of the common causes of the anal fissure are:

• Passing hard and large stools
• Straining during bowel movements & constipation
• Inflammation in the anorectal area due to inflammatory bowel disease (Crohn’s disease)
• Childbirth
• Chronic diarrhea

Some of the less common causes of anal fissures include anal cancer, tuberculosis, syphilis, herpes, & HIV. Infancy, aging and anal intercourse increase the risk of developing anal fissure.

What are the complications of anal fissures?

A fissure may cause complications such as:

• Poor healing and chronic fissure: Poor or slow healing of fissures lead to a chronic state which may need further treatment. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla).
• Recurrence: There are high chances anal fissure will recur.  
• Tear in surrounding muscle: The anal fissure may extend to the surrounding muscles (internal anal sphincter), which delays healing. When anal fissure remains unhealed for more than 6 weeks, the patient requires medication or surgery to reduce pain, repair or remove the fissure.

How are anal fissures diagnosed?

The physician will carefully evaluate the medical history & anorectal symptoms and perform a digital rectal examination under anesthesia. Any fissure on the side of the anal opening is called as Crohn’s disease. In such cases the doctor may perform:

• Flexible sigmoidoscopy: A thin, flexible tube with a tiny camera is inserted into the colon to inspect the area inside. Anyone younger than 50 years without risk factors for intestinal diseases is eligible.
• Colonoscopy: A flexible tube is used to inspect the entire colon. This test is for those who are above 50 years of age and have risk factors for colon cancer or who show signs such as abdominal pain or diarrhea.

What is the recovery like from surgery for anal fissure?

In most cases, complete healing occurs within 8 weeks after surgery. It is important to discuss the post-surgery care and recovery. Some pain and discomfort in the area after surgery is common. However, the pain due to surgery is lesser than the pain due to fissure itself. After surgery, it is common to be temporarily unable to control gas and experience mild fecal leakage or infection. Most fissures respond well to surgeries and for easy recovery doctor may recommend:

• Soaking the affected area in a warm bath
• Painkillers
• Laxatives and stool softeners for a week
• Fiber-rich diet

References