Chronic anal fissure

What is chronic anal fissure?

An anal fissure is a small ulcer or sore on the inner margin of the anus that causes various symptoms such as itching and bleeding during bowel movements as well as for some time afterwards.

It is considered as a chronic anal fissure when the symptoms persist for more than eight weeks. In addition, usually when it is chronic, the tear is deeper and external or internal fleshy growths may appear.

Prognosis of the disease

It is not a serious pathology, whether it is a chronic fissure or not. There are treatments with medications and ointments to treat chronic anal fissure, and surgery is rarely required.

Symptoms of chronic anal fissure

Symptoms of chronic anal fissure are as follows:

  • Pain during bowel movements, sometimes severe.
  • Pain after a bowel movement, which may last several hours.
  • Bloody stools or stools on the toilet paper after defecation.
  • Small lump on the skin next to the anal fissure.

After eight weeks, it is considered chronic anal fissure.

Medical tests for chronic anal fissure

Initially, the specialist will ask the patient about his or her medical history. He will then perform a physical examination, including a simple inspection of the anal region. Usually the tear is visible, so this is usually sufficient to diagnose the pathology.

In case there is an underlying condition, the physician may require some additional tests, such as:

  • Anoscopy
  • Colonoscopy
  • Flexible sigmoidoscopy
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What are the causes of chronic anal fissure?

The initial formation of the sores or ulcers can be caused by various reasons, among which chronic constipation stands out. The following causes are also common:

  • Bowel movements with large, hard stools.
  • Straining during defecation
  • Chronic diarrhea
  • Anal sex
  • Childbirth

Finally, there are other less common reasons such as inflammatory bowel disease, syphilis, HIV, anal cancer or tuberculosis.

Can it be prevented?

There are some measures that can help prevent anal fissures, such as avoiding constipation or diarrhea. To avoid chronic anal fissure, it is important to see a specialist to start early treatment of anal fissure, as well as to control those factors that have caused it.

Treatments for chronic anal fissure

Treatment in the initial phase is based on following a series of dietary and hygienic measures. In addition, the patient should apply a series of healing ointments that will help the muscle relaxation of the anus. In the event that the adequate result is not achieved, the injection of botulinum toxin usually achieves a stronger and faster effect.

If conservative treatment does not work adequately, surgery, known as internal sphincterotomy, is performed, where a small cut is made in the lower area of the involuntary anal musculature, with the aim of reducing spasm and pain, favoring healing. With this surgery, the pathology is cured in 98% of the cases.

Which specialist treats it?

Chronic anal fissure should be treated by a specialist in Coloproctology or a specialist in General Surgery.