An anal fissure is a small wound of less than 1cm that appears at the margin of the anus. It can appear at any age (even during infancy). However, it tends to be more common in young adults, affecting men and women equally. Fissures are almost always located in the posteriormost part of the anus.
Anal fissures are important because they cause severe pain during defecation which can last for several hours due to sphincter spasms.
Why does an anal fissure occur?
There is no clear cause but it seems that the triggering mechanism of anal fissures is usually a trauma to the mucosa of the anal canal, either by the passage of hard stool (constipation) or as a result of having suffered a major diarrhea. It is also related to stress.
What are the symptoms of an anal fissure?
The main symptom of an anal fissure is an intense pain in that area, especially with defecation, which can normally last for hours. In advanced cases, this pain can even occur when straining, urinating or coughing. This, in fact, causes many patients to be afraid to go to the bathroom in case it hurts. This pain is usually accompanied by fresh red blood, in small amounts.
In many patients, a hard nodule is seen at the anal verge just where the fissure is located. This is called a sentinel hemorrhoid or skin tag.
Typical of anal fissure is that it is cyclical and recurrent, i.e. it becomes more intense over time and the attacks will be longer lasting.
How are anal fissures diagnosed?
When the patient explains in the consultation of the specialist in Coloproctology that he/she suffers intense pain during defecation, an anal fissure may already be suspected. However, the specialist will make a careful physical examination. A digital rectal examination is not performed because in these patients it is very painful. The patient should be positioned properly and the edges of the anus should be gently separated slightly to observe the beginning of the fissure.
Treatment of anal fissure
In cases of acute anal fissure (appearing for the first time) and if the wound does not reach the internal anal sphincter, treatment should be with Diltiazem 2% ointment, accompanied by sitz baths with warm water and a muscle relaxant.
If medical treatment fails, both in acute anal fissure and chronic anal fissure, surgery will be proposed. In addition to the intense pain of the fissure, there is an important risk of infections in that area, as well as the appearance of more serious pathologies, such as anal fistulas or abscesses.
If surgery is necessary, the technique of choice is lateral internal sphincterotomy. It consists of sectioning the small portion of the internal anal sphincter that is most tense and is causing the fissure. It is undoubtedly a very grateful operation, with good results, since, by loosening the muscle, the wound can heal and soothe the pain.
The most commonly used technique at present is the CO2 laser, a very exclusive treatment that few specialists perform:
- It makes it possible to locate with certainty the internal anal sphincter and what proportion to cut.
- The patient can be discharged a few hours later.
- It heals quickly
- It is a highly hemostatic and painless technique.
- It allows a return to normal life after 24-48 hours.