Anal fissure is a common condition, affecting people of any age or sex and presents as a cut or tear in the anal canal.
Anal fissure classification
Acute anal fissures are symptomatic for a few weeks. They can be managed with dietary changes, such as increased fibre, or with stool softeners, which ease defaecation.
Chronic anal fissures fail to heal and are symptomatic for longer periods.
Risk factors for anal fissure
Most anal fissures result from physical trauma, usually as a consequence of constipation and passing hard stool. Other risk factors include:
• Recurrent or chronic diarrhoea;
• Certain medication;
• Underlying medical conditions such as
• Crohn's disease, ulcerative colitis or
Symptoms of anal fissure
Although the fissure may be quite small, patients can experience:
• Severe, excruciating pain;
• More intense pain during defaecation;
• Presence of bright red blood in the stool
• or on toilet paper;
• Pain that can persist for an hour or two
• after defaecation.
Most idiopathic anal fissures are associated with increased tone of the internal anal sphincter and reduced blood flow in the anal canal. Associated ischaemia may contribute to the pain and contribute to impaired healing.
Chronic anal fissure: Treatment aims
Treatment should relieve the symptoms, promote healing and improve quality of life. The treatment aims for these patients should be to:
• Reduce the intense pain;
• Relax the internal anal sphincter;
• Improve blood flow in the anal canal.
This can be achieved either surgically or with a medicine. Surgery involves cutting the internal anal sphincter to reduce tone but there is a significant risk of causing a mild to moderate faecal incontinence. Medical first line treatment is thus preferred.