Anal fissure

What is an anal fissure?

An anal fissure is essentially a wound, a “tear” along the longitudinal axis of the mucous membrane of the anus. This wound is deep and reaches the muscular layer of the anus to the fibers of the internal sphincter of the anus. It usually appears below the dentate line of the anus. The usual position if we imagine the anus as a clock is at 6 o’clock. That is, towards the side of the coccyx. A satellite skin tag is created around the fissure and outwards, which is likely to be mistaken for a hemorrhoid by someone without experience. In the case of multiple fissures in various parts of the circumference of the anus points towards an inflammatory bowel disease, such as Crohn’s disease.


What causes an anal fissure?

The fissure is initially caused by an injury to the anus. The tear/wound as described above usually occurs in people with constipation. The latter causes dehydrated-hard stools which, as they pass from the anus during defecation, injure and tear the mucous membrane of the anus, initiating the vicious cycle of fissures.

Less commonly, the injury may be due to anal intercourse, itching of the anus, or a surgical scar (e.g. after hemorrhoid surgery) that has not healed properly.

The fissure wound causes excruciating pain during defecation. The intense pain somehow creates a spasm of the anal sphincter. In chronic conditions, this leads to a hypertonic, hypertrophic anal sphincter. Which in turn further narrows the anal canal and makes it even more difficult for feces to pass through. This difficulty instigates a phobia in the patient who avoids bowel movements, enhancing the constipation and worsening the above-mentioned vicious cycle.


How is anal fissure diagnosed?

The diagnosis of anal fissure is relatively easy since the crack in the skin is visible to the naked eye. An endoscopy is performed upon suspicion of another health problem.


What are the characteristic symptoms of anal fissures?

Typically, patients with anal fissures complain of very severe burning and cutting pain during defecation, which can last up to 4-5 hours and is sometimes accompanied by minor blood loss. The patient then remains free of symptoms until the next defecation.


How is anal fissure treated?

The treatment of anal fissures can either be conservative or invasive. Conservative approaches aim at combating constipation with laxatives and ointment preparations containing nitrites and/or local anesthetics. The effectiveness of these methods is limited.

The surgical treatment is painless, bloodless, short and effective.

The main axis of the treatment is the partial lateral internal sphincterotomy, which relieves the patient of the chronic spasm of the sphincter and facilitates the rapid healing of the fissure. This operation must be performed by a specialized surgeon to avoid incontinence. In addition, the fissure is cleaned using modern energy tools (RF – monopolar cautery).

This operation lasts 20-30 minutes, is performed with a laryngeal mask (LMA) and the patient returns home the same day. The patient’s relief after these operations is impressive and highly satisfying both for him and for us treating physicians.


What happens after surgery?

Post-operatively, it is necessary for the patient to follow a specific diet and, if in pain, to take a mild analgesic. Within a very short time, the pain decreases and in a few days disappears.


Fissures in children

Anal fissures cam be a complication of constipation that persists in a child. It is initially treated with proper nutrition and some ointment.


Anal fissure and diet: What should we eat?

A balanced and proper diet is a form of conservative treatment for anal fissures. Include fruits and vegetables in your diet (greens, green salads, seasonal fruits, natural juices) and drink plenty of water throughout the day. In this way, episodes of constipation that cause pain are also avoided.

Make an appointment with the doctor to find out more information as well as the cost for laser treatment.