An anal fissure is a small rip or tear in the lining of the anal canal, usually caused by trauma to the area from a bowel movement or other stretching of the anal canal. This can be due to hard, dry stools (constipation) or loose, frequent bowel movements. Patients with a tight anal opening are more likely to develop anal fissures.
Symptoms & Diagnosis
Anal fissures typically cause pain that starts with passage of stool and can persist for some time after. The pain is often described as “sharp” or the feeling of “passing razor blades or shards of glass”. Bright red blood can occasionally be seen on the toilet paper or stool. A small lump or tag can be felt at the outermost extent of the fissure, just outside of the anal opening. A fissure can be diagnosed with an exam in the office.
Treatment Options
- Initial treatment of a fissure includes:
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- High fiber diet and/or over the counter fiber supplement (i.e. Metamucil)
- Over the counter stool softener (i.e. Colace, or generic, 100mg twice a day)
- 64 oz of water daily
- Warm tub soaks or sitz baths at least daily
- Medications such as diltiazem or nitroglycerin ointment to relax the sphincter muscle and aid in the healing process
- Surgery may be an option for a fissure should medical therapy not be successful (this is more likely to be the case with chronic fissures). The procedure involves making a small cut in the sphincter muscle that surrounds the anal opening (“lateral internal sphincterotomy”). This is typically done as a same day procedure in the operating room and is successful in healing the fissure in 90% of cases. Post-operative complications include bleeding, infection and, rarely, a change in the ability to control bowel function.
- In select circumstances, injection of Botox into the anal sphincter muscle may be offered as therapy for a fissure that does not heal with use of topical ointment.