Anal Fissure Treatment in Delhi, India

Anal fissure is a tear in the lining of the anus, the opening through which the stool is passed out of the body. An anal fissure can occur for multiple reasons. However, the most common is passing large or hard stools during a bowel movement. Anal fissures can cause a sensation of tearing, burning, or tipping during bowel movement. Anal fissures are quite common and can occur in anyone at any age. However, they are often confused with other anal conditions, like haemorrhoids.

Symptoms

Common symptoms of an anal fissure include:

• Sharp pain during bowel movement
• Constipation
• Visible tear in the anus
• Discomfort or itching in the anal area
• Streaks of blood on the stool
• A small lump on the skin near the anus

Causes

Anal fissures usually occur due to hard or large bowel movements. The condition is caused by trauma to the inner lining of the anus. Chronic constipation can also tear the skin around the anus, causing an anal fissure. It can also be caused due to anal stretching. In some cases, an anal fissure may develop due to underlying conditions like herpes, syphilis, HIV, and more. Other causes include:

• Spastic anal sphincter muscles
• Scarring in the anal area
• Decreased blood flow to the anorectal area
• Inflammatory bowel diseases such as Crohn's disease
• Chronic diarrhoea
• Anal intercourse
• Childbirth
• Post-radiation therapy - local radiation

Types

Anal fissures can be classified as follows:

• Acute Anal Fissure: These fissures are healed within six weeks by conservative treatment.
• Chronic Anal Fissures: These fissures can persist for more than six weeks. These types of fissures may need surgical treatment.

Apart from this, anal fissures are categorised as primary and secondary fissures. The primary anal fissure is short-lived and occurs due to an injury to the local tissues. The injury may be caused due to passage or large or hard stools, chronic diarrhoea, childbirth, and more. Secondary anal fissures often occur due to an underlying condition or surgeries in the anus, inflammatory bowel disease, infections, and more.

Diagnosis

Your doctor will ask about your symptoms and will perform a physical examination to look at the anal fissure by proctoscope if needed, or possible sigmoidoscopy is recommended.

Treatment & Procedure

Treatment for anal fissure may not be necessary as it often heals within a few weeks with conservative treatment. However, in chronic anal fissures, the doctor might recommend surgery.

• Medications: Antibiotics are advised to treat the anal fissures. The doctor may also recommend using over-the-counter stool softeners, glyceryl trinitrate (GTN) ointment, and calcium-channel blockers to treat anal fissures.
• Botox Injections: In some cases, the doctor may recommend Botulinum toxin type A (Botox) injection into the anal sphincter. The injection temporarily paralyses the muscle, which helps speed healing and relieves pain caused due to anal fissures.
• Lateral Internal Sphincterotomy: The surgeon makes an incision on a small portion of the anal sphincter muscle, which reduces spam and pain.
• Sitz Baths:Soaking the anal region in warm water for 10 to 20 minutes several times a day can help to relax the anal muscles and promote a speedy recovery.

Risks

Anal fissures are generally non-threatening and heal within a few weeks. However, it can result in other complications like chronic anal fissures, perianal abscesses, anal fistulas, and anal stenosis in some instances.

Recovery & Outlook

The outlook for anal fissure is generally good. Acute fissures can be easily treated with home treatment, including using stool softeners, lifestyle changes, a high-fibre diet, sitz baths, and more. However, not all fissures are healed with home treatment. In this case, surgical treatments are required. After the surgery, most patients can return to day-to-day work after a few days. Total recovery can take 6 to 10 weeks. But in some refractory cases of acute fissures in ano - Lateral sphincterotomy (LSIS) may be needed.

Review

Reviewed by Dr. Alok Gupta, Associate Director, Institute of Minimal Access, Laparoscopic & Bariatric Surgery on 11-August-2023.