July 23, 2024

Comprehensive Guide to Anal Fissure Treatment: Navigating the Painful Journey from Causes and Symptoms to Non-Surgical Interventions, Topical Medications, and Surgical Fissurectomy Procedures, Along with Potential Risks, Recovery, and Long-Term Prevention Strategies

Anal Fissure Treatment: Managing the Painful Condition

Anal fissures are small tears in the lining of the anus. They often cause intense pain and bleeding during bowel movements. Here is an overview of anal fissure treatment options.

Causes of Anal Fissures

Hard bowel movements or prolonged periods of constipation are common causes of anal fissures. The passage of hard stool can traumaize and tear the delicate anal tissue. Other possible causes include:

– Childbirth: Passing a large baby can cause anal tears, especially if instrumentation like forceps were used.

– Diarrhea: Frequent, loose stools that move through the colon quickly do not provide enough moisture and may damage the anal tissue.

– Crohn’s disease or ulcerative colitis: Inflammatory bowel diseases sometimes cause anal fissures as a secondary complication.

– Anal infections: Conditions like herpes or human papillomavirus (HPV) can inflame the area and lead to fissures developing.

Symptoms of Anal Fissures

Some key symptoms of anal fissures include:

– Severe pain during bowel movements that may last for hours after
– Bright red bleeding from the anus after bowel movements
– A tight, tearing sensation or discovery of skin tags at the anal opening
– Itching or irritation around the anus
– Bowel movements that have become more difficult or painful over time

Failure to seek treatment can cause anal fissures to persist for months or even years in some cases.

Non-Surgical Treatment Options

For most mild to moderate cases, initial treatment starts conservatively without surgery. Some common non-surgical options include:

Diet and Lifestyle Changes
– Increasing dietary fiber intake and staying hydrated to soften stools
– Avoiding straining during bowel movements and going when the urge is strong
– Sitz baths or warm water soaks for 15-20 minutes, 2-3 times per day to relieve pain and itching

Topical Medications
– Nitroglycerin or diltiazem ointments applied to the anal area can help relax the anal sphincter muscle and promote healing
– Corticosteroids like hydrocortisone can reduce inflammation and ease pain

Pain Relievers
– Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen help manage pain
– Prescription opioids may be needed in severe cases until the fissure has healed

If non-surgical treatment does not yield results within 6-8 weeks, other options may be considered.

Surgical Fissurectomy Procedures

For chronic or recurring anal fissures that do not respond to conservative treatments, surgery may be recommended. The main surgical procedures include:

Lateral Internal Sphincterotomy

This is the most common procedure for chronic fissures. It involves making a small cut in the internal anal sphincter muscle under anesthesia, either as an outpatient procedure or with an overnight hospital stay. Cutting the sphincter muscle promotes relaxation, eases pressure and tension in the anal area to allow the fissure to heal properly in 6-8 weeks.

Fissurectomy with Advancement Flap

If the fissure is large or has resulted in significant scarring, a fissurectomy may be performed. In this procedure, the fissured area is excised down to healthy tissue below. Then a nearby part of the anal lining is mobilized and sutured over the excised area to cover it and promote healing by secondary intention.

Potential Surgical Risks

Like any surgical procedure, there are possible risks and side effects to consider, including:

– Infection of the surgical site
– Delayed healing or failure of the fissure to heal fully after surgery
– Urinary incontinence or flatulence issues due to sphincter muscle complications
– Recurrence of the fissure in 5-15% of cases after internal sphincterotomy
– Need for repeat surgeries if initial treatment does not provide lasting relief

Recovery and Prevention

It can take 4-6 weeks to recover fully from a surgical fissure procedure. Follow-up with a colorectal surgeon is important to monitor healing. Prevention strategies like improving bowel habits, hydration, dietary changes, and treating constipation or other conditions can help avoid anal fissures from recurring long-term. With appropriate medical management, most people find effective relief from this painful disorder.

Anal fissures can develop due to various causes but often improve with conservative non-surgical measures initially. Surgery provides relief for chronic cases but requires recovery time. Adopting a prevention-focused lifestyle can help many people avoid anal fissures or reduce the chances of recurrence. Consultation with a gastroenterologist or colorectal surgeon is recommended if pain or bleeding persists. With proper treatment, most fissures can heal successfully.

1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it