Anal Fissures / Fissure in Ano
What is a fissure?
It is a small crack in the
surface of the lowest and very sensitive portion of the bowel
(See diagram). It is probably the result
of a minor injury whilst straining. Many patients remember
the initial injury.
What are the symptoms?
- Anal/Rectum Pain.
During a bowel movement there is a tearing or burning sensation
as the fissure is being forcibly opened. After finishing
the bowel movement the pain often persists for a time.
- Anal/Rectum Irritation.
The pain sometimes shows itself as irritation rather than
pain. The itching is increased as a result of the moisture
surrounding
the fissure.
- Anal/Rectum Bleeding.
This is scant. The patient may notice the relationship
between the appearance of bright red blood and a painful
bowel action.
- Lump.
A lump in the anal region makes the patient believe that
he has painful haemorrhoids. This is incorrect. The
pain is due to the
fissure and the lump is a small skin tag below the
fissure.
- Constipation.
This is both the cause and the result of fissure formation.
It is often wrongly treated with purgatives.
- Narrow
Motions.
The muscles surrounding the region are thrown into
contraction causing the motions to be thin and sometimes
string like.
What is the Treatment?
Minor Fissure.
If the fissure is not severe and of recent origin it may only
cause mild problems. It is best treated by avoiding hard
motions and causing them to be bulky and soft. This would
gently stretch
the back passage and allow the fissure to heal. The stretch
is important. Purgatives which cause liquid motions must
be avoided. Soft bulky motions are the result of plenty of
vegetable
fibre in the diet. Unprocessed wheat bran-2 heaped tablespoons
in milk every day will often cause the desired result. Minor
fissures of recent origin will heal by this simple technique.
Another helpful treatment is with Glyceryl trinitrate cream which is sparingly applied in the anal canal and the surrounding area. This causes the sphincter muscle which surrounds the anus to relax allowing the blood supply to the fissure to improve. Healing is thereby encouraged. This treatment has the disadvantage of causing headaches. If these are severe and cannot be relieved with paracetamol tablets the treatment must cease.
The cream can also be helpful with more severe fissures, however it commonly fails to have a permanent effect.
Major
Fissure.
Treatment of fissures which have been present for a long
time or with more severe symptoms is pain free provided
the patient
is adequately sedated, and a local anaesthetic injection
is given. The area is stretched and if necessary a tiny
cut is made to
relieve the spasm of the anal sphincter which is responsible
for the narrow motions. The patient can go home after an
hour or so. This treatment is nearly always successful
and the patient
can return to work after a few days.
There are problems with this treatment which if carefully performed is safe. The patient should be made aware that occasionally there may be incontinence of wind following the procedure. Fortunately this problem usually settles within three months. On extremely rare occasions incontinence of faeces can ensue.
Anal fissure and tag as shown by arrows.
IMPORTANT
Subsequent tests.
Fissures and all the above symptoms can be the result of a
more serious condition inside the bowel which must be investigated
either before or after the treatment. This can be done by inspecting
the bowel partially (sigmoidoscopy) or totally (colonoscopy).
Your doctor will advise you about these tests which are important.
For
further information please talk to your Doctor
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