What Are the Treatments for Anal Fissure and Which Specialist Should I Consult?

Anal fissure is an impairment of the wall of the anus. It usually does not come with a lot of medical complications. Nonetheless, it should be treated with urgency, since it can make life very uncomfortable for you.  

Anal Fissure Symptoms

Anal fissure comes with a number of symptoms. Since some of these are similar to those of other health conditions, it is advisable to consult your doctor for a proper diagnosis. These are the symptoms of anal fissure:

• Presence of blood in your stool
• Experiencing pain for a period of time after bowel movements
• Itching or irritation around the anus area
• An actual cut in your anus
• A burning sensation during bowel movements

Types of Anal Fissure

• General – It is possible to get either acute or chronic anal fissure. They are categorized as either primary or secondary depending on whether the trigger is known or unknown.

• Acute & chronic anal fissure - Acute anal fissures are associated with a lot of pain during visits to the bathroom. They are not easily seen since they are usually superficial, though they do take some time to heal. Acute or short-term anal fissure usually takes 4 to 6 weeks to heal with home treatment. Meanwhile, chronic anal fissures usually cause less pain than acute anal fissures do. Nevertheless, chronic anal fissures form ulcers when they become deeper, thus taking more than 6 weeks to heal or not healing at all. Internal anal sphincter spasms prevent a good supply of blood to the fissure, impairing the healing process. The non-healing ulcer can be infected by fecal bacteria.

• Primary and secondary anal fissure - Primary anal fissure is usually found in the posterior anal midline, although a small percentage is found in the anterior midline. What triggers primary anal fissure is unknown in most cases. Secondary anal fissures, meanwhile, result from inflammatory bowel disease, previous surgery, or infectious diseases such as venereal diseases. Herpes, tuberculosis, cytomegalovirus, chlamydia, and HIV are infections commonly associated with secondary anal fissure.

Diagnosis

• Diagnosis is often initiated as a result of pain or bleeding during bowel movements. A specialist can usually identify an anal fissure simply by performing some examinations or going through the patient’s medical history.
• A rectal examination involves inserting a gloved finger into the anal canal. However, it is rarely performed on a patient because it is too painful. A visual exam that involves an anoscope is performed instead.
• A sample of the rectal tissue will be extracted for diagnosis if the fissure cannot be seen.
• Other tests are not necessary unless symptoms show an underlying bowel disorder or the doctor wants to eliminate other disorders. Some of these additional tests are colonoscopy, flexible sigmoidoscopy, and anal manometry.

What to Expect from Your Doctor

Below are some of the questions you should expect from your doctor:

• Where are the symptoms felt the most?
• Are the symptoms serious, and if so, how serious?
• Is there anything that seems to improve your symptoms?
• When did you begin to feel the symptoms?
• Have you been experiencing the symptoms frequently?
• What seems to make the symptoms worse?
• Do you suffer from any other medical condition, for instance Crohn’s disease?
• Is your stool hard?

Treatment

Treatment can be categorized into different types:

• General - Treatment is not necessary in some cases of anal fissure and heal on their own within a few weeks. But if need be, the first priority given are the home-based treatments. Non-surgical treatments may be given to relieve pain and facilitate healing in some cases, and surgical procedures may be performed as necessary--that is, if the fissure fails to respond to treatment and develops into chronic anal fissure.
• For Infants - Ensuring their adequate intake of fluids and changing their diapers frequently are advised.
• Home care methods - These treatments are mostly applicable in cases of acute anal fissure:

1. Exercising frequently at least 30 minutes every day
2. Applying petroleum jelly to the anal opening
3. Lots of fluid intake
4. Gentle cleansing
5. Using a stool softener
6. Avoiding straining during a bowel movement
7. Use of fiber supplements in your diet
8. Using sitz baths - A sitz bath involves sitting in very warm water for at least 15 to 20 minutes every day.
9. Increasing the fiber content in your diet, for example, through the consumption of nuts, vegetables, fruits, grains, beans, and psyllium, a fiber             supplement

A. Non-Surgical Treatments (Medications)

• These treatments are used to relieve muscle pain around the affected area. They include muscle analgesic or anesthetic numbing creams. They are for external use around the wound.
• Numbing creams include calcium channel blockers, zinc oxide, and topical nitroglycerine. Creams with nitroglycerine enhance blood flow to the wound, thus enabling healing. However, while nitroglycerine has such an advantage, it carries with it some complications, for instance, severe headaches, dizziness, and low blood pressure. It is thus advisable to apply the cream either when lying down or seated. Men should avoid using nitroglycerine within 24 hours of taking any erectile dysfunctional medication, since the combination could lower the blood pressure significantly.

B. Surgery

Surgery is considered when the fissure takes too long to heal. Treatment for surgery includes lateral internal sphincterotomy, or anal stretch. The main objective of this surgery is to eliminate sphincter spasm, allowing for normal blood flow to the area.

1. Lateral internal sphincterotomy (LIS) - This is for patients under general anesthesia and is usually a same-day surgery. Lateral internal sphincterotomy involves slightly dividing the internal anal sphincter, which enables the supply of blood and loosens the sphincter. This procedure generally has a high success rate but may have some complications like the incision or the sphincter taking long to heal, and post-surgical pain. The healing of the lateral internal sphincter usually takes about a week.
2. Anal dilation - This is the stretching of the anal canal, and it is less often performed than LIS. Gas and fecal incontinence are the complications commonly associated with it.
3. Dermal flap coverage - This is the treatment used to treat anal fissures through the use of a skin flap to cover the fissure. This procedure has reduced complications and therefore appeals to more and more patients.

Other less popular surgical treatments are:

-          Tailored anal sphincterotomy - The sphincter is more preserved in this case than in lateral sphincterotomy.

-          Fissurectomy - This involves the removal of the anal fissure.

-          Anal advancement flap - This involves replacing the damaged tissue with good tissue.

The Colorectal Surgeon: The Specialist Who Performs Anal Fissure Surgery

A colorectal surgeon is also known as a proctologist. This specialist is a recognized surgeon who has gone through training in the treatment and diagnosis of diseases of the colon, anus, and rectum. Colon and rectum diseases require well-trained and experienced surgeons for the surgical and non-surgical treatments of both types of diseases. These surgeons do routine colon examination, treat benign and malignant conditions, and, of course, perform surgery related to the colon and rectum when necessary.

A colorectal surgeon performs or orders the necessary procedures to make a diagnosis after evaluating the symptoms below:

• Bowel incontinence
• Anal fissure
• Pain in the anus
• Anal warts and fistula or other anal abscesses

Visit your doctor if you have any of the above symptoms.