Proctology

What is an anal fissure?

Anal fissure is a common disease that affects people of all ages.

An anal fissure is a tear of the anal skin that cause itching, discomfort, bleeding, and dull pain during and after defecation.

It can be acute or “short – term”, which heals by itself in few days, and chronic or “long – term” with no healing in 12 weeks.

When a patient has a chronic anal fissure, and a proper medical therapy has been already attempted, surgery is advised. 

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What causes an anal fissure?

Anal fissures can be caused by:

  • Passage of large and/ or hard stool
  • Repeated diarrhea
  • Childbirth that can also cause trauma to the anal canal
  • Prolonged muscular spasm

In fact, the extra tension in the two muscular rings (sphincters) controlling the anus may cause fissure as well. The outer anal sphincter is under your conscious control but the inner sphincter is not. This muscle is under pressure, or tension, all of the time for keeping the anal canal closed. If the pressure increases too much, it can cause spasm and reduce blood flow to the anus, leading to a fissure. This pressure can also prevent the fissure from healing. 

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What are the symptoms?

  • A sharp burning pain during bowel movements, lasting from few minutes to several hours after a bowel movement
  • Anal bleeding, normally is a small spot of bright blood on toilet tissue or drops in the toilet bowl. The blood from a fissure is separate from the stool, not mixed with it
  • Anal itching and peri-anal skin irritation
  • Sentinel polyp – if anal fissure is left untreated, a small skin tag called – “sentinel polyp” will at the apex of the fissure, it can reach a large size and becomes noticeable by the patient
  • Feeling of a partial blockage in the anus. The fissure irritates the muscle that is reacting with involuntary spasm which makes physically difficult to pass stool.

Treatment for anal fissure:

Initially, medical therapy with special local ointment, stool softener and pain killers is attempted.

If the fissure is not healing in 3 months and scar tissue is forming, then surgery is the only way to guarantee healing to the patient.

Normally, surgical cauterization (diathermy) under sedation is the only necessary treatment. Contextual sentinel polyp asportation is mandatory.

In more advanced cases, anal flap fashioning is necessary in order to make the fissure healing correctly.

In the few cases where the muscle spasm is the main causative component, a little incision on the inner sphincter might be necessary, always taking utmost care to safeguard the continence.

All the procedures are performed with minimally invasive techniques, allowing the patient to be operated in a Day Surgery setting, with less pain and quick return to daily activities.

 

The proctologist at the proctology clinic at our center provides better diagnosis of hemorrhoids, hemorrhoid treatment, hemorrhoidectomy, hemorrhoid surgery and thd hemorrhoids.

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