Dr Naseem Mirbagheri:
A fissure is a tear in the inner lining of the anal canal, similar to a paper cut on your hand. This tear is usually very painful and usually results in spasm of the sphincter muscles, which are the muscles around the anus.
This tear is usually caused by the passage of hard stool but can also happen after severe diarrhoea, childbirth or any other form of trauma. Unlike skin elsewhere on our bodies, the anus skin doesn’t heal easily, probably because it doesn’t have a good blood supply, which means the fissure may persist and become an ulcer.
The commonest symptom is intense pain during the passage of stool that may last for a time afterwards, usually because of the muscle spasm. Fissures are also associated with fresh bleeding, usually on wiping. However, if you do have bleeding it’s important to see your doctor to exclude more important causes.
The treatment of anal fissure involves softening the stool with high fibre diet and drinking lots of fluid. And sometimes using an ointment that relaxes the muscle around the anal canal, such as a GTN (glyceryl trinitrate) or diltiazem.
If the bowel habit is not improved, you can get a recurrence of the fissure. Fissures which don’t heal after six weeks of such treatment and become chronic can be helped by an injection of BOTOX or by cutting the sphincter muscles. Both these techniques help to relax the muscle and help expedite the healing of the ulcer. However, BOTOX only lasts for a few months, so the procedure may have to be repeated to achieve a complete response.
On the other hand, cutting the sphincter muscles (technical name lateral sphinceterotomy), is the gold standard surgical treatment option for managing chronic fissures. And it has more than 90 per cent success rate. However, it is associated with small but important complications such as delayed wound healing, incontinence of gas and, very rarely, incontinence of faeces.
So in summary, a fissure is a split or a tear in the skin of the anal canal which, although very small, can cause significant pain and bleeding. Treatment is readily available and you must see your doctor for advice. Remember that all bleeding from the back passage must be checked out.