Anal Fissure

An anal fissure is a small tear or cut in the lining of the anal canal.

• Constipation: Hard stools causing trauma.
• Chronic diarrhoea.
• Anal intercourse.
• Childbirth trauma.
• Inflammatory bowel diseases (less common).

• Acute: Less than 6 weeks’ duration.
• Chronic: More than 6 weeks’ duration, may have an external skin tag (sentinel pile) at the distal end.

• Severe, sharp pain during and after bowel movements.
• Bright red blood on the toilet paper or in the stool.
• Pruritus (itching).
• A visible tear or cut near the anus (on inspection).

• Generally clinical diagnosis.
• Anoscopy or proctoscopy: If other diagnoses are being considered or if the fissure doesn’t heal with treatment.

• Conservative:

  • Bulk-forming laxatives to soften stools (e.g., ispaghula husk).
  • Sitz baths: Warm water baths for symptomatic relief.
  • Topical anaesthetics (e.g., lidocaine) for pain relief.

• Medical:

  • Topical glyceryl trinitrate (GTN): Reduces anal sphincter spasm.
  • Topical calcium channel blockers (e.g., diltiazem).
  • Botulinum toxin injections: Temporary paralysis of the anal sphincter.

• Surgical: Reserved for chronic fissures not responding to treatment.

  • Lateral internal sphincterotomy: Most common surgical treatment.
  • Fissurectomy: Removal of the fissure and any underlying scar tissue.

• Chronic pain.
• Abscess or fistula formation.
• Incontinence (rare and usually temporary, especially after surgery).

• High-fibre diet to prevent constipation.
• Regular fluid intake.
• Avoiding straining during bowel movements.