Anal Fissure
What Is it?
A fissure is a tear or split in the lining (mucosa) of the anus.
What are the Symptoms?
Anal fissures may cause:
• Pain with bowel motions.
• Bright red bleeding. Any bleeding from the bowel needs to be properly investigated.
• Aching after bowel motions.
• Itching.
• Anal lump. At the lower end of the fissure a skin tag may form causing a lump or bump at the opening to the anus.
What caused it?
· Fissures are commonly associated with hard stools, constipation or sometimes diarrhoea.
· Anal fissures are also common in women after childbirth and in patients with Crohn’s disease.
· Fissures happen when the anal muscles contract too tightly (spasm).
· The two muscles that surround the anal canal are the external anal sphincter (which we can control) and the internal anal sphincter (involuntary muscle). With an anal fissure the internal muscle is in spasm.
· Blood flow to the fissure (tear) is reduced by the muscle spasm making it hard for the tear to heal.
What is the treatment?
What’s the outcome?
· In acute fissures (less than 12 weeks of symptoms) medical therapy is successful in 70 – 90% of patients.
· For botox the healing rate is around 70% for one injection and can be repeated.
· For sphincterotomy healing rates of up to 95% have been quoted.
What Is it?
A fissure is a tear or split in the lining (mucosa) of the anus.
What are the Symptoms?
Anal fissures may cause:
• Pain with bowel motions.
• Bright red bleeding. Any bleeding from the bowel needs to be properly investigated.
• Aching after bowel motions.
• Itching.
• Anal lump. At the lower end of the fissure a skin tag may form causing a lump or bump at the opening to the anus.
What caused it?
· Fissures are commonly associated with hard stools, constipation or sometimes diarrhoea.
· Anal fissures are also common in women after childbirth and in patients with Crohn’s disease.
· Fissures happen when the anal muscles contract too tightly (spasm).
· The two muscles that surround the anal canal are the external anal sphincter (which we can control) and the internal anal sphincter (involuntary muscle). With an anal fissure the internal muscle is in spasm.
· Blood flow to the fissure (tear) is reduced by the muscle spasm making it hard for the tear to heal.
What is the treatment?
- Acute fissures (less than 12 weeks of symptoms) can often be treated with lifestyle changes – these include a change in diet, pain relief and stool softeners.
- There are also medications that can help acute fissure to heal including GTN paste.
- If the anal fissure does not go away with non-surgical methods, treatment may involve methods to relax the internal sphincter muscle. These include:
- Botox injections into muscle in the anus (anal sphincter).
- Surgery to relax the anal muscle (sphincterotomy).
What’s the outcome?
· In acute fissures (less than 12 weeks of symptoms) medical therapy is successful in 70 – 90% of patients.
· For botox the healing rate is around 70% for one injection and can be repeated.
· For sphincterotomy healing rates of up to 95% have been quoted.