Anal fissure is a wound, cut or “crack”, which appears on the anal margin towards the inside. It may extend to the dentate line.
Causes of anal fissure
Anal fissures have their origin in situations of constipation with passage of hard stool and straining during bowel movements. They can also be caused by frequent diarrheal bowel movements. This is generally due to a deficit of blood irrigation in this area and the fissure is produced.
Hypertonia of the sphincter (contracture) also leads to a poorer blood supply in the area and favors the appearance of fissures. It is difficult to know which occurs first, the fissure or the hypertonia. What we do know is that the existence of sphincter hypertonia hinders fissure healing.
There are other conditions that can cause anal fissures, such as inflammatory bowel disease, childbirth or infections that occur in the area, among other causes.
Symptoms of anal fissure
- Pain during bowel movements that may last for a shorter or longer period of time
- Scant bleeding in the stool or paper
- Itching and stinging
- Small lump on the skin in chronic fissure
- Difficulty passing stool
How is it diagnosed?
To diagnose anal fissure, an anorectal examination is performed, where the wound is observed. Sphincteric hypertonicity is usually also noted. Frequently, the fissure appears in the posterior part of the anus. An anuscopy can also be performed, but this is usually not possible because it causes pain.
Medical treatment
Most acute fissures can be resolved by medical treatment:
- Avoid constipation, through a diet rich in fiber and fluids.
- Warm sitz baths
- Use of anesthetic creams
- Use of healing creams
- Use of nitroglycerin, an ointment to help increase blood flow and relaxation of the sphincter.
- Use of diltiazem or nifedipine, ointments that produce anal sphincter relaxation
- Botox
Surgical treatment (chronic fissure)
If the anal fissure is chronic, the patient must undergo a surgical procedure called lateral sphincterotomy, which consists of cutting a portion of the internal anal sphincter muscle. This is a very effective procedure, which causes little postoperative pain. In addition, the risk of incontinence is minimal if performed according to established indications and techniques.