An Anal Fissure is defined as a small tear or cuts in the skin around the anal canal. It causes pain and bleeding with bowel movements. The depth of the fissure can be either superficial or deep and extending to the underlying sphincter muscle.
An Anal Fissure is not a medical emergency.
Anal Fissures can be acute and chronic:
Acute Anal Fissure: An acute Anal Fissure appears as a fresh tear and heals within 4 to 8 weeks of conservative medical management.
Chronic Anal Fissure: A chronic Anal Fissure presents with raised edges and fails to heal with conservative management. It extends to the surrounding muscle and can result in a sentinel pile or an anal fistula.
Anal Fissures are of two types:
Primary fissures: Primary fissures are caused due to straining of bowel movements, defecating hard stools, prolonged diarrhea, during vaginal delivery, and anal intercourse. They are located in the posterior or anterior position.
Secondary fissures: Secondary fissures are caused as a result of previous anal surgery or due to inflammatory bowel disease, granulomatous diseases, infections, or malignancies. They are located in a lateral position and appear as multiple fissures.
Anal Fissures are very common in infants and can also occur at any age. They can be caused due to several reasons, which include:
Factors that influence the development of Anal Fissure are:
Signs and symptoms of an Anal Fissure include:
Investigations of an Anal Fissure include a physical examination of the anal region. Other procedure and investigations include:
A diagnosis of an Anal Fissure is established based on medical history, clinical evaluation, and results of the investigations done.
Anal Fissures heal on their own within 4 to 8 weeks. Most of the primary Anal Fissures can be treated with simple methods like warm sitz baths, topical ointments, increased fluid intake, high-fiber diet, and stool softeners. Multidisciplinary management is required in cases of cancers that are present along with fissures.
If symptoms persist, the following medical treatments are recommended:
If there is a failure of conservative management, surgical procedures are required for the treatment of Anal Fissures. These mostly include lateral internal sphincterotomy(LIS). A small portion of the anal sphincter muscle is cut and removed to reduce pain, relax the muscle, and promote the healing process.
Diet modifications and lifestyle changes can prevent Anal Fissures and can avoid their recurrence. Some of them include the following:
Complications of Anal Fissures include:
The overall prognosis of an Anal Fissure is good. Mild to moderate Anal Fissures can be treated with conservative management and severe cases can be dealt with surgical treatment.
It is always advisable to consult a physician after noticing:
Acute Anal Fissures resolve with medical treatments. Chronic Anal Fissures that fail to resolve with conservative management, cause persistent pain and rectal bleeding, and those that result in sentinel pile formation, etc. Require surgical treatment and hospitalization.