Anal fissures

These are tears or cuts in the anus and anal canal.
They affect both men and women equally.

They may present as acute conditions (occurring in a short period of time) or chronic condition (a condition that has persisted over a considerable length of time).

Anatomy

Untreated fissures develop a hood-like skin tag which covers the fissure and cause discomfort, or pain.

Anal fissure anatomy

Symptoms

Pain on defecation. The pain can be severe enough that patients will try and avoid going to the toilet, thus leading to constipation. It can also lead to some difficulty with urination.
Bleeding with bowel motion
Itchiness to the bottom
Discharge.

Occasionally pus may be discharged from the area.

Causes

Trauma
Anal fissure can be caused by passage of large hard stool or repeated diarrhoea.
Other traumatic causes include insertion of foreign bodies and childbirth.

Others:
These are rarer causes of anal fissure:

Crohn’s disease
Anal cancer
Infections – herpes, HIV, Chlamydia.

Diagnosis

Anal fissures are often diagnosed based on the history and a direct physical examination. Sometimes the physical examination may be done under general anaesthetic as the pain and elicited tenderness is too severe for the examination otherwise.

Management

General management

Avoid constipation. This involves in ensuring that the diet has adequate fibre as well as ensuring adequate hydration. Stool softeners may also be beneficial.
Sits bath. This involves soaking the bottom in warm water after bowel movements.

Medical management

Topical anaesthetics (e.g. Lignocaine ointment) – Used prior to bowel motion.
Steroids – Often combined with topical anaesthetic ointment.
Nitrogylcerin ointment.
Calcium channel blockers (e.g. Knifepoint ointment).

Surgery

Surgical management

Botulinum toxin injection:

Paralyses the sphincter muscle
Effect may be temporary.

Lateral sphincterotomy
A small cut is made into the internal anal sphincter muscle, corresponding to the length of the fissure.

98% healing rate at 2 months.
0–3 % recurrence rate.

Lateral sphincterotomy

Complications

Postoperative management

Clinical Associate Professor Hairul Ahmad MBBS FRACS

Upper Gastrointestinal, Advanced Laparoscopic and General Surgery
Perth, Western Australia

Practice Details

Suite 12, Waikiki Specialist Centre,
217 Willmott Drive, Waikiki WA 6169

Please call (08) 9592 2298 for an appointment.
Fax: (08) 6314 1524
or email us