Anal Fissure
Dr. Mahesh Krishna provides expert treatment for anal fissures, which are small tears in the anal lining causing pain and discomfort. Using advanced techniques, he ensures effective healing, pain relief, and long-term well-being for his patients.
Anal Fissure
An anal fissure is a split or tear in the lining of the anus (anal mucosa).
The presenting symptoms are pain and bright red blood per anus.
Treatment involves laxatives and surgery.
Symptoms
The signs and symptoms of anal fissure could be:
pain around the anus
pain while passing a motion and for several hours thereafter
bright red rectal bleeding
bleeding onto the surface of the stools
smears of blood on toilet paper.
Causes Of Anal Fissure
Some of the causes are:
• chronic constipation
• passing a dry, hard stool
• tough or excessive wiping of the anus after passing a motion
• diarrhea
• inflammation of the anus and rectum
• Crohn’s disease
• scratching (due to reaction to pinworm infection, for instance)
• Anal injury
• pregnancy
• childbirth
• cancer of the rectum.
Complications Of Anal Fissure
Anal fissures are not related to other more serious illnesses, like bowel cancer, though anal cancer can present similar to anal fissure. Among the potential complications of an anal fissure are:
• Chronic anal fissure – the fissure doesn’t heal. Eventually, this leads to significant scar tissue where the fissure is (sentinel pile).
• Anal fistulas – abnormal ‘tunnels’ connect the anal canal to surrounding organs, most commonly other organs of the bowel.
• Anal stenosis – narrowing of the abnormally anal canal
Diagnosis Of Anal Fissure
An anal fissure is diagnosed with a variety of tests such as:
• physical examination
• examination of the rectum and anus with a thin instrument (anoscope).
Treatment For Anal Fissure
Medical management of an anal fissure can involve:
• pain medication
• laxatives
• anaesthetic creams
• nitroglycerin creams or Botox injections to relax the spasm of the associated muscle.
• surgery
Surgery For Anal Fissures
Serious anal fissures must be operated on. The fissure and related scar tissue are excised.
Occasionally, a thin piece of muscle from the anal sphincter is also taken out, as this aids the healing of the wound. (Cutting and stitching this muscle does not affect the patient’s control of their sphincter.) The procedure, known as a lateral internal sphincterotomy, can be done under local anesthetic. Nine out of 10 individuals will never have another anal fissure.
Lateral Internal Sphincterotomy
During this procedure, your doctor will create a small side incision into your internal anal sphincter. (Side means from the side.)You have two anal sphincter muscles that encircle your anal canal and regulate your bowel movements. The inner ring is the internal sphincter, and the outer one encircles it. The outer one is voluntary, but the inner one is involuntary. This one remains contracted as a default, and only relaxes for bowel movements.
Your doctor will make an incision directly into the muscle below your anal fissure to relieve tension. The goal is to decrease the constant pressure by 20% to 50%. This should eliminate spasms and increase blood flow, allowing your fissure to heal. They’ll find the anal fissure by inserting an anoscope (speculum), and then they’ll use a scalpel, electrocautery or Laser to make an incision into the muscle below.
It usually takes 30 minutes for the procedure itself. The entire appointment could be two or three hours.
Laser anal fissure surgery
Laser surgery of anal fissures is a very minor invasive procedure that uses a concentrated laser light to carefully slice the anal sphincter muscle. This is done with care to ensure that it enhances the blood supply to the site of the fissure, which accelerates healing and minimizes pain. Performed on an outpatient basis, it has the advantages of less postoperative pain and faster recovery when compared to standard surgical techniques. It’s deemed to be a useful option in chronic anal fissures’ management and causes minimal invasiveness to give relief.
