What is Anal Fissure or Fissure-in-ano?

Anal Fissure is a tear in the anus causing a painful linear ulcer at the margin of the anus. It may cause itching, pain or bleeding. Fissures can extend upward into the lower rectal mucosa; or extend downward causing a swollen skin tag to develop at the anal verge, also known as a sentinel pile.

What are the causes of Anal Fissure?

Anal fissure is caused by anything which would cause injury to the anal canal. These could be either extreme constipation or diarrhea, usually combined with nervous tension over a prolonged period of time, may produce anal abrasions, simple slit-like fissures, or acute ulcers at the anal verge. With constipation, this condition is usually caused by the passage of a hard dry stool that tears the anal lining upon defecation. With diarrhea, this condition is usually caused by an over use and over-wiping of an inflamed anal canal…Read More

What are the symptoms of Anal Fissure?

Severe pain is the main symptom of acute anal fissure. Fissure produced pain at defecation may persists for hours. A small amount of bright red blood, which may or may not be mixed with stool, is common. A fissure produces pain disproportionate to its size . An inadequately treated fissure may lead to chronic fissure in which pain is relatively less and persists intermittently for weeks and months.

How is Fissure diagnosed?

Diagnosis can be made by inspection. Closer inspection will frequently reveal a tag or sentinel pile. After gentle separation of the skin of the anal verge, the ulcer usually posterior can be seen. Frequently the fibers of the internal anal sphincter muscle can be seen at the base of this punched-out ulcer. A well-lubricated finger with lidocaine ointment and a small caliber anoscope will help delineate the extent of the lesion. A colonoscope or sigmoidoscope exam might be useful to rule out abscesses, colitis, and other causes of rectal bleeding. A fissure should be distinguished from an ulcer caused by Crohn’s disease, leukemia, or malignant tumors, because it is not shaggy, large or indolent. Fissures are seldom multiple. A biopsy can help to determine the diagnosis.

How is Anal Fissure treated?

Surgical Treatment
When surgical excision is required, the chronic fissure along with the sentinel pile, papilla, and adjacent crypts are dissected free from the underlying muscle. Associated internal and external hemorrhoids are removed. Usually the scar tissue in the posterior anal quadrant is completely denuded. The criteria for excision of fissures are chronicity and association with other anorectal disease such as hemorrhoids, mucosal prolapse, skin tags, enlarged papillae, anal contraction, and diseased crypts…Read More

Medical treatment
At least 50 percent of fissures heal by themselves without the need for an operation. The longer that a fissure has persisted over time, the less likely it will be to heal by itself. Oftentimes, acute fissures heal by themselves spontaneously, with good anal hygiene consisting of a thorough cleansing after each bowel movement. The use of sitz baths (soaking the anal area in plain warm water for 20 minutes, several times a day) helps to relieve fissure symptoms, but may not actually aid in the healing process. A topical hydrocortisone preparation applied to the folds of the anal verge several times a day will help to relieve symptoms and aids the healing process…Read More