Anal fissure is a very common pathology of consultation to doctors specializing in Coloproctology. It stands out for causing episodes of bleeding and pain in the anus. At Top Doctors we have Dr. Javier de Oca Burguete, coloproctologist expert in anal fistula surgery, who explains how anal fissures appear.
Anal fissure: characteristics treatment
Anal fissure is a very frequent pathology that causes a high number of consultations with the specialist of reference, a proctologist. It essentially consists of a small cut or wound, which appears on the anal margin, which in the beginning can be very superficial but which over time can become more and more serious. Most of the time, the fissure is located on the posterior aspect of the anus. That is to say, if we imagine the anus as a clock, it would be located at six o’clock.
How and why does an anal fissure appear?
The appearance of an anal fissure is closely linked to certain disorders in stool habits. Generally, constipation or the presence of very hard stools are the causes most often associated with the appearance of a fissure, although it can also be triggered when stools are very liquid and/or very frequent.
Other less frequent causes are childbirth, Crohn’s disease and anal intercourse. The age of presentation is highly variable and anal fissures are not uncommon in infants and the elderly.
Main symptoms of an anal fissure
The most frequent symptoms are pain and bleeding. The former is triggered during defecation and usually lasts for a few hours. Hemorrhage is almost always manifested by the presence of blood on the toilet paper, although on other occasions it may be drops of blood that fall into the toilet after bowel movements and even reach a significant hemorrhage, which logically generates alarm in the patient. Other symptoms that may accompany the fissure are itching in the anal area and the presence of a small wart next to the fissure itself.
The diagnosis should always be made by a specialist proctologist, who will examine the patient and eventually request a colonoscopy to rule out other diseases.
How to treat anal fissure and how to improve its symptoms
More than 50% of anal fissures improve with conventional measures such as bidet sitz baths, diet regulation and the use of ointments. Among the latter, the most commonly used are those containing Glyceryl Trinitrate, Diltiazem or epithelializing ointments. This treatment regimen should be prolonged for 6 to 8 weeks.
Surgical treatment is reserved for those cases in which conservative measures have failed or in which the condition has recurred after a period of improvement.
Among all the surgical options, the most classic consists of performing a small section of a part of the internal sphincter, which facilitates general relaxation of the sphincteric apparatus and relieves the symptoms. This operation does not necessarily cause any impairment of the patient’s ability to retain stool, i.e. continence. The operation can be performed by day surgery. Recovery is very rapid and the patient can return to normal life within a short period of time.