What is anal fissure?
Anal fissure is a painful tear (wound) in the lining of the anal canal that extends from the muscular layer of the anus to the fibers of the internal sphincter of the anus. It is usually caused by injury to the skin of the anus after the passage of large or hard bowel movement (especially in cases of chronic constipation) in combination with increased activity (hypertonia) of the anal sphincter.
What are the symptoms of an anal fissure?
Anal fissures can be classified as acute or chronic, based on both chronology and morphology. They are considered to be acute if they have been present for less than 6 weeks and chronic if they have been persisted for more than 6–8 weeks (despite conservative treatment) and have different morphological manifestations.
One of main symptoms of the anal fissure is the very strong pain immediately after a bowel movement (like tearing or burning), which can last 2-6 hours and is sometimes accompanied by little bleeding.
The detection of multiple fissures in various parts of the circumference of the anus indicates the coexistence of inflammatory bowel disease and especially Crohn’s disease (secondary anal fissure).
What is the treatment for the anal fissure?
Initially, anal fissures can be treated conservatively by applying special ointments for a period of 4-6 weeks. The disadvantages of the ointments application are the side effects (severe headache that forces patients to stop the treatment in the 30% of the cases) and the relapse which reaches the 50%.
The second line of conservative treatment is Botox injections. In this case, the disadvantages are the cost and the need for repeated treatment.
The safest and most permanent treatment is surgery. The surgical treatment of anal fissure is called lateral internal sphincterotomy. In this procedure, the surgeon will cut the lower part of the internal sphincter muscle. This will eliminate the chronic spasm and facilitate the rapid healing and the prevention of recurrence. It is an easy and permanent solution. The patient should stay in hospital for 24 hours.
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