Anal Fissure

With the term anal fissure we mean a wound in the form of an elongated slit (1-2 cm) in the anal ring. Its most frequent location is in the 6th gynecological hour, where it appears in 90% of cases. In 9% of cases, anal fissures are detected at the 12th gynecological hour, while the remaining 1% concern in atypical positions in the anal ring.

The wound of anal fissure most often involves the mucosal wall of the anus. But, in some cases it can go deeper and reach the muscle wall, which makes it more difficult to treat.

Anal fissure: Etiology

The most common cause is sudden injury to the area most often caused by constipation. It should be emphasized that even a hard bowel movement can lead to an anal fissure. Other causes that can cause anal fissures are:

inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
persistent diarrhea
anal sex
normal childbirth

In rare cases anal fissure can be caused by:

rectal cancer
tuberculosis
syphilis
herpes
HIV virus

Anal fissure symptoms

The main symptom is sharp pain in the area. This pain is often characterized by patients as unbearable. It worsens during bowel movement and lasts for several hours after it. We also often have rectal bleeding with bright red blood in the stool or on the toilet paper.

The symptoms are very similar to those caused by hemorrhoids, with the difference that the pain lasts longer. If anal fissure was caused in the last 6 weeks it is classified as acute and otherwise as chronic.
Pain in the area causes a reflex contraction of a muscle of the anus (internal sphincter). This contraction leads to reduced blood supply to the fissure, which makes it difficult to heal.. Often the pain is accompanied by itching of the area, while the appearance of skin tags next to the anal fissure is also possible.

Anal fissure: How is it diagnosed?

The diagnosis of anal fissure is made during the clinical examination by a specialized proctologist. In some cases, a proctoscopy may also be necessary, which is performed in the doctor’s office.

Treatment

The treatment of anal fissure is initially conservative and, after failure, surgical. It should be treated by a General Surgeon and preferably a colorectal surgeon.
Conservative treatment of anal fissures

Conservative treatment includes:

• Diet rich in fiber, plenty of fluids, fruits and vegetables.
• Analgesic creams and special ointments that cause relaxation of the internal anal sphincter and increase blood flow to the area in order to heal the anal fissure. Disadvantage of these ointments is that they must be used for a long time as well as the severe headache they cause in several cases
• Mild laxatives to “soften” the stools and prevent the area from being irritated by hard stools.
• Hot water baths 3-4 times a day. (Fill the bathtub with warm water and soak the anus in it for 15-20 minutes. This process relaxes the muscles and increases blood circulation in order to heal the anal fissure faster).
• Avoid toilet paper and wash with cold water and baby wipes
• Injection of special material in the anus area that can also be done in the doctor’s office. With this injection we cause relaxation of the internal sphincter of the anus. Thus, we allow good blood supply to the anal fissure and consequently its healing. This relaxation lasts about 3-4 months, a period capable of leading to the healing of the fissure. This method has a success rate of up to 70% according to the international literature.

Anal Fissure & Surgical treatment

Surgical treatment is recommended for chronic anal fissures and failure of conservative treatment. It involves excision of the fissure using laser or diathermy and most often simultaneous partial medial lateral sphincterotomy of the internal anal sphincter. In the hands of an experienced rectal surgeon, it is an operation that does not cause complications.
It is a completely painless, bloodless procedure, performed with general or epidural anesthesia and the patient leaves the clinic the same day. The results are impressive. The pain of the anal fissure subsides to a large extent from the first day and the patient returns to activities immediately.

General Surgeon Alexandros Kyritsis has extremely extensive experience in the pathology of the anus and colon. The doctor is specialized in colorectal Surgery and is the most suitable for treating anal fissures. Contact us and book your appointment to receive from Dr. Kyritsis personalized diagnosis.

FREQUENT QUESTIONS

My anus hurts a lot. Do I have anal fissure?

There are various conditions that can cause severe pain in the anus area. Hemorrhoids and perianal abscess also cause pain and may confuse the patient. Anal fissure usually have sharp pain especially after bowel movement that lasts for hours unlike hemorrhoids and abscesses.

. Which doctor should I vist if I suspect that I have anal fissure?

The appropriate doctor to treat this condition is the specialized colorectal surgeon.

I have been diagnosed with anal fissure. Should I have surgery?

In case of acute anal fissure, conservative treatment has high cure rates. In the case of chronic anal fissure or failure of conservative treatment, then the appropriate treatment is operation.

I have been diagnosed with chronic anal fissures but I don’t have much pain. Do I still need to have to have surgery?

A chronic anal fissure, even if it does not cause any particular symptoms, can over time lead to the creation of a fistula. Therefore, in case of failure of the conservative treatment, it would be preferable to treat it surgically.

How long should I apply the conservative treatment?

Conservative treatment is applied for a period of about two months. If the symptoms are still present then we go ahead with surgical treatment.

How much does the surgery cost and how long do I have to stay in the clinic?

The cost depends on patients insurance but in any case it is not particularly high. The patient is operated in the clinic and after 4 hours he leaves with instructions.

How much time do I have be off from work if I have surgery for anal fissure?

The patient can return to work normally the day after the surgery.

Can anal fissure cause cancer?

Absolutely not. Anal fissures cannot cause cancer.

Is there a possibility of incontinence if I have surgery for anal fissure?

In the hands of an experienced colorectal surgeon this possibility is considered extremely unlikely.

How long should I refrain from anal sex in case of surgery?

The patient must abstain from this particular sexual activity for a period of 6 months.