Anal Fissure Treatment: Alleviating Pain and Facilitating Healing through Nonsurgical and Surgical Approaches
Anal Fissure Treatment: Relieving the Pain and Promoting Healing
Anal fissures are small tears or cracks in the anoderm, the skin around the anal opening. They cause pain and bleeding during bowel movements. Left untreated, anal fissures can become chronic and cause ongoing discomfort. Treatment focuses on relieving symptoms and allowing the tear to heal properly.
What Causes Anal Fissures?
Several factors can contribute to the development of anal fissures, including constipation, diarrhea, anal intercourse, and childbirth. Anything that causes excessive pressure or stretching in the anal area increases the risk of tearing the anoderm. Constipation is one of the leading causes as it results in hard, dry stools that can damage the skin when passed.
Constipation occurs when stools are large or hard and difficult to pass. The pressure required to pass these stools can exceed the flexibility of the skin and cause tears. Other possible causes include diarrhea, which results in loose, liquidy stools that pass quickly and dehydration of the anoderm. Anal intercourse or vaginal delivery can also put undue stress on the anal area.
Symptoms and Diagnosis
The main symptoms of an anal fissure include a sharp pain or burning sensation during bowel movements, bright red blood on the toilet paper or stool after a BM, and a rigid, tight anal sphincter muscle. Some people also report pain radiating into the buttocks, lower back or genitals.
Diagnosis is usually made during a physical examination by the doctor. Anoscopy or proctoscopy may be used to visualize the anal canal and confirm the presence of a fissure. In some cases, high-resolution anoscopy may be used to get a clearer view of the tear. Additional tests are not usually necessary for an uncomplicated case.
Nonsurgical Treatment Options
Most anal fissures are initially treated nonsurgically to promote healing and relieve symptoms. The goal is to reduce pressure in the anal area and allow the tear time to heal. Some common nonsurgical treatments include:
Stool softeners and fiber supplementation: Fiber bulks up stools and softeners retain fluid to make BMs easier to pass. This reduces straining and pressure.
Topical nitroglycerin or calcium channel blockers: Medicated creams like nitroglycerin work to relax smooth muscle fibers in the internal sphincter, reducing spasm pressure and promoting blood flow to the area.
Warm water soaks: Warm water cleansing after BMs can help wash away stool particles irritating the fissure and provide temporary pain relief.
Diet modification: Avoiding constipation triggers like caffeine and staying hydrated improves stool consistency and transit time.
If nonsurgical treatments fail to provide sufficient relief after 6-8 weeks, other options may be considered.
Surgery for Anal Fissures
For chronic or recurring anal fissures that do not heal with conservative measures, surgery may be recommended. The most common surgical procedure is a lateral internal sphincterotomy. During this procedure:
- An incision is made just inside the anus to cut a small portion of the inner sphincter muscle. This serves to reduce pressure and allows the fissure room to heal.
- It is performed under general or local anesthesia on an outpatient basis, with a short recovery time.
- Success rates are high, with over 90% of fissures healed after surgery and relief of symptoms.
- Risks are minor but may include brief incontinence or rarely, infection. However, continence usually returns to normal within a few weeks.
Other less common options include fissurectomy to excise the fissure edge or advances procedures like BOTOX injections to relax the sphincter. Surgery provides the best chance for long term healing of chronic fissures.
Preventing Recurrence
Even after initial healing, there remains a risk of the anal fissure recurring due to leftover spasm or tension in the anal area. Maintaining a high fiber diet, staying well hydrated and using topical agents as needed can help prevent this.
Learning pelvic floor relaxation techniques may also aid in reducing pressure. Reoccurrence is more common in those with underlying conditions like inflammatory bowel disease which require long term management. Follow up with a colorectal surgeon can help monitor progress and address any additional risk factors.
With proper treatment selection and lifestyle modifications tailored to the individual case, the majority of patients can expect excellent relief of their anal fissure symptoms and promote long lasting healing. Addressing both causes and physical factors through medical and surgical means provides the best outlook.
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