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Anal Fissure

Anal Fissure

An anal fissure is a persistent tear in the lining of the anal canal that does not heal on its own and typically reaches to the border of the anus. It’s generally found inside the anal canal and cannot be felt by touching with the finger.

The most frequent indications of this condition are intense pain in the anal area and bleeding while having a bowel movement. These symptoms arise when the anal fissure is stretched as stools pass through. Occasionally, patients may detect a small extra piece of skin, called a Sentinel Skin Tag, located at the edge of the anus, which typically appears with an anal fissure. This skin tag is usually painless and can be removed during surgery for the anal fissure.

Most individuals with an Anal Fissure usually report an episode of passing hard stools that preceded the development of symptoms. It is postulated that the passage of hard stools may have caused an acute tear that subsequently develops into a chronic non-healing anal fissure.

The development of anal fissures usually occurs in a subset of susceptible patients, namely those with high resting anal muscle tone. This is however not a conscious nor voluntary action on the part of the individual. As a result of the high resting anal pressure, the anus will get overly stretched out during the passing of motion and hence leading to an acute tear. Due to a decreased blood supply from the high resting anal pressure, the tear does not heal and ends up as a chronic non-healing tear.

Treatments for Anal Fissure

There are two types of treatments available for anal fissures – pharmaceutical (using medication) and surgical. Typically, medication is the initial choice for patients and surgery is only recommended for those who do not respond to medication or experience recurring anal fissures.

There are two common medications prescribed to treat anal fissures that work by relaxing the anal muscle and promoting healing. The success rate for medication treatment is over 60%, although recurrence of the condition is common after completion of the treatment.

Surgery is considered as a secondary treatment option for anal fissures when patients do not respond to or experience adverse effects from medication. Additionally, surgery may be recommended for patients who experience recurrent anal fissures despite completing medication treatment. The specific type of surgery used for this condition is called Lateral Sphincterotomy, which involves cutting a portion of the anal sphincter muscle to disrupt the muscle ring and reduce the resting anal tone. During the same procedure, the skin tag can also be removed. It is worth noting that there is a small chance of flatus or gas, as well as occasional leakage of liquid stool from the anus following this surgery.