Anal fissure is a tear or a small cut within the anal canal. This often occurs following a hard motion. It does not heal easily, and can form a small chronic ulcer.
Anal fissure is usually very painful, causing an intense sharp and tearing pain at the time of defecation, and often lasting for some time after. Fissures often cause bleeding on the stool. They may heal themselves over time, or require further medical or surgical management.
Treatment of anal fissure is aimed at healing the fissure. Initial management includes ointments to help relax the muscles of the anal canal and increase the blood supply to the tissue for healing to occur. Stool softeners are also useful to decrease the pain, and to decrease the repeat tearing on defecation. The aim of treatment is also to avoid outright diarrhea, in order to optimise the chances of healing.
If ointments fail, and the fissure does not heal over time, muscle-relaxing injections may be used. However, the risk of recurrence with this is significantly high. Sometimes, if the fissure still fails to heal despite multiple measures, a lateral sphincterotomy procedure is performed under anesthetic, as the procedure with the greatest success, and the least risk of recurrence. This procedure is only recommended for patients who do not have any history of anal sphincter muscle weakness in the past.
