What can cause an anal fissure?
An anal fissure is a longitudinal wound or tear in the anal mucosa, i.e. the tissue lining the anus. The typical location is at the anterior and posterior anal margin. The most common causes of anal fissure include:
- Expulsion of large or hard stool.
- Constipation and straining during bowel movements.
- Chronic diarrhea
- Inflammation of the anorectal region, caused by Crohn’s disease or other inflammatory bowel disease
- Childbirth
Less common causes of anal fissures include:
- Anal cancer
- HIV
- Tuberculosis
- Syphilis
- Herpes
What symptoms does the patient with an anal fissure notice?
Signs and symptoms of an anal fissure include:
- Pain, usually severe, during bowel movements that may last up to several hours after bowel movements.
- Bright red blood in the stool or on the toilet paper after a bowel movement
- Itching or irritation around the anus
- A visible crack in the skin around the anus
- A small lump or skin tag on the skin near the anal fissure
What is the most appropriate treatment for anal fissure?
The presence of this wound in the anus triggers a reflex contraction of the anal musculature (called “hypertonia”), which prevents an adequate blood supply to the fissure, preventing proper healing of the fissure and a perpetuation of this disease, establishing a vicious circle. For this reason, the treatments applied are aimed at overcoming this muscular contracture or hypertonia. The treatment will depend on whether the fissure is acute or chronic:
- If the fissure is acute the indicated treatment will be:
- Sitz baths in warm water, which relaxes the muscles that are contracted and thus help to improve the pain.
- Application of healing creams and sometimes anesthetics to help with the evacuation.
- In selected patients, nitroglycerin ointments are indicated, which have a high percentage of healing, although they produce headache.
- Intestinal lubricants/laxatives
- Analgesia
- If the fissure is chronic, it has little response to conservative treatment. In these cases, surgical treatment is indicated. The technique is carefully decided with each patient, sometimes an endoanal ultrasound is requested to assess the sphincteric apparatus prior to surgery.
Currently, the role of regenerative medicine and its application in the healing of fissures is being assessed, and the path is promising, given that the patient’s sphincteric architecture is respected.