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Anal Fissure Evaluation and Treatment

Anal fissures are acute or chronic tears within the anal canal that usually span from the end of the rectum to the anal verge.  The tear is frequently related to constipation or diarrhea.  The primary symptom reported by patients is severe pain. Patients suffering from anal fissure will off to report a large or hard bowel movement prior to the acute onset of severe pain. An additional symptom of anal fissure is bloody bowel movements.

 

Evaluation of Anal Fissures

If symptoms have been present for less than 8 weeks, the tear is classified as an acute anal fissure. If symptoms persist past this point, the diagnosis is a chronic anal fissure.  With a chronic anal fissure, there are characteristic changes of the anal canal including exposed sphincter muscle or a sentinel skin tag at the end of the fissure.

If the patient experiences severe, unrelenting pain after bowel movements, they should be evaluated by a colorectal surgeon for a possible anal fissure.  Your surgeon will take a detailed history of her symptoms and any associated risk factors for anal fissure.  After this, year colorectal surgeon will inspect the anal area with a focus on minimizing discomfort and pain. The diagnosis of anal fissure can usually be made without painful or invasive examination.

Treatment for Anal Fissures

Initially, the management of anal fissures is non operative.  After the diagnosis is made, your surgeon will recommend warm Sitz baths and increasing your daily fiber intake to bulk up and soften your bowel movements. Your colorectal surgeon may also prescribe topical steroids or anesthetic ointments to decrease the acute pain.

If the acute symptoms do not resolve or if the patient has symptoms consistent with a chronic anal fissure, your surgeon can prescribe topical ointments to relieve the spasm of your anal sphincter muscles.  The thought process behind these treatments this to decrease the painful anal spasm and allow the tear to heal.

If topical therapies are unsuccessful, Botox injection into the anal fissure is another treatment with a very low risk of complications that helps to allow the tear to heal. This is performed in an operating room with the patient under anesthesia.

If all other therapies have failed to heal the anal fissure, the most definitive treatment is called a lateral internal sphincterotomy.  This involves partially dividing the sphincter muscle with the goal of decreasing anal spasm and allowing the fissure to heal completely.  This is the most definitive and effective treatment for anal fissure.  There is a very low risk of fecal incontinence after this procedure. This is an outpatient surgery that should only be performed by a colorectal surgeon.

After your anal fissure has been successfully treated by a colorectal surgeon, it is important to maintain a high-fiber diet and to drink plenty of water to prevent constipation or diarrhea which could lead to recurrence of the fissure.

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