Anal fissure

What is an anal fissure?

It is a painful crack in the internal lining of anus. This condition is common in all age groups. It is not a cancer.

How is it caused?

In patients who have constipation hard stools may tear the internal lining and cause an anal fissure. Some of these are associated with childbirth. Rarely, it is because of another illness such as tuberculosis or a type of inflammatory bowel disease known as Crohn's disease.

What are the symptoms?

Passing stool is very painful and this pain may persist. Occasionally there is bright red bleeding that may stain the stool or come in drops.

How is this condition treated?

Some fissures get better without any special treatment. However, most require treatment, as it is a very painful condition.

1. Steroid ointments, painkillers, local anaesthetic creams and warm baths relieve pain but do not help in healing.
   
2. Nitroglycerin (0.2%) applied locally twice daily every day for 6 weeks will cure about 70% of these fissures. This ointment is very difficult to obtain in India. The side effects of this ointment application include troublesome headaches and even faintness.
   
3. Quick healing can be achieved by partially dividing the anal sphincteric muscle, but this requires an operation.
   
4. Anal dilatation is a rather crude method of overcoming spasm of the anal sphincter and this may result in complete damage to the sphincter especially in women.

When is an operation necessary?

If the fissure does not get better on its own and there is a lot of pain, it is advisable to have an operation called lateral internal sphincterotomy.

In this operation, the surgeon examines the patient under anaesthesia, may take a biopsy if he thinks it is necessary and cuts the anal sphincter partially. Often, a portion of skin that sits just below the fissure called sentinel pile is also removed. Once the sphincter is divided, pain relief is instantaneous and the fissure heals rapidly as the blood flow to that area increases.

What are the problems associated with it?

After this operation minor leakage of stool for a variable length of time may occur. The ability to distinguish between wind and stool may be lost temporarily. There is complete recovery in almost all the cases.