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An anal fissure is a small tear in the skin around the opening of the anus (the end of the back passage). The symptoms of anal fissures are:
Anal fissures can occur at any age but are seen more in young adults between the ages of 20-40. They affect both men and women equally and can occur in childhood
The most common cause of an anal fissure is constipation and passing hard stool, which can damage the lining of the anal canal.
Other causes may be persistent diarrhoea, passing loose stools frequently, childbirth and inflammatory bowel disease
If you see blood in your stool or any other symptoms of an anal fissure you should visit your GP.
Anal fissures usually heal within a few weeks without any need for medical treatment, but this is not the case for everyone. One common problem is that severe pain may cause people to avoid passing stools, triggering the symptoms of constipation, which may prevent the fissure from healing and lead to chronic anal fissures. Switching to a high fibre diet should help recovery by making it easier to pass stools.
While many anal fissures will heal by themselves, some may require medication. There are a number of treatments that will help the fissure to heal, as well as ease the symptoms.
Softening stools: This allows stool to pass more easily, reducing pain and aiding the healing process. This can be done by increasing the amount of fibre in the diet or through medications called laxatives. These will help your stools retain water, which will make them softer and more bulky.
Medications:
Topical (medicine that you apply directly onto the affected body part) anaesthetics such as lidocaine could be used to numb the area and ease the pain.
Topical Glyceryl Trinitrate 0.2-0.4 %(GTN) is another treatment that can be used if symptoms do not improve, which acts to increase blood flow by expanding nearby vessels, which can help the fissure to heal.
Topical Diltiazem Cream 2% It increases blood flows to smooth muscles and relaxes muscle tone. Topical diltiazem hydrochloride is not licensed in the UK for treating chronic anal fissure or any other indication. Therefore, its use for treating chronic anal fissure is unlicensed.
Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The healing rate is dependent on the BTX dosage. The short-term healing rate (≤ 6 months) is 60–90%, whereas about 50% of the patients show a complete response in long-term follow-up studies (> 1 year).
THD Levorag(®) Emulgel proved to be effective for the re-epithelization of AF and the reduction of pain in the short term in about 80 % of patients. Its use for treating anal fissure is unlicensed a recent trial has demonstrated good results compared with routine treatment and the medication can be purchase from: levorag.co.uk
If the fissure does not respond to treatment then you may be referred for further treatment, which could involve some form of surgery. The most common type of surgery used is called advancement flap and internal sphincterotomy. This involves a general anaesthetic and can often be done without requiring an overnight stay in hospital, but can, very rarely, lead to permanent incontinence. Your doctor will explain the options available to you and the risks involved,
Fissures can reappear and a fully healed fissure may come back if a hard stool is passed, which causes further damage. One of the best ways to prevent fissures returning is to avoid becoming constipated. Some methods to prevent constipation are:
