Annal Fissure

The anus is the opening at the end of the digestive tract where stool leaves the body; the rectum is the section of the digestive tract above the anus where stool is held before it passes out of the body through the anus.

An anal fissure is a tear or ulcer in the lining of the anus.

An injury from a hard or large stool movement may cause anal fissures. Fissures cause the anal sphincter (muscle) to go into spasm, which prevents healing.

Fissures cause pain and bleeding, usually during or shortly after a bowel (stool) movement. The pain lasts for several minutes to several hours and then subsides until the next bowel movement. A doctor diagnoses a fissure by inspecting the anus.

Treatment

A stool softener (laxative) reduces the possibility of reinjury by hard bowel movements, while lubricating and soothing the lower rectum. Lubricant suppositories also can be helpful. A warm sitz bath for 10 to 15 minutes after each bowel movement eases discomfort and helps increase blood flow, which promotes healing.

Promising experimental treatments have been developed to reduce sphincter spasm and promote healing of fissures, including injection of the sphincter with toxins from Clostridium botulinum bacteria and application of nitroglycerin ointment or calcium channel blockers to the area of the fissure.

When these measures fail, surgery may be needed. Sphincter spasm can be relieved by partially dividing the internal sphincter muscle (lateral anal sphincterotomy) with immediate results.

Submitted By:
Dr Ravindran Kumeran
Consultant Surgical Gastroentrologist
Chennai – India

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