A B C D E F G H I J K L M N O P R S T U V W

ANAL FISSURES

What are Anal Fissures ?

A fissure is a split or tear within the back passage (anal canal).

How do Anal Fissures occur ?

A fissure is the result of passing a hard bowel motion. This produces a tear which is painful while opening the bowels. Because of the pain, bowel actions are therefore avoided. The constipation then becomes worse. Just as the fissure begins to heal, a further hard motion is passed. This reopens the split and a vicious circle of events follows. The condition may become chronic if the constipation remains untreated.

Why do Anal Fissures occur ?

They occur because the bowel motion has become hard. This may result from irregular eating habits and the lack of fibre in the diet. Straining to go to the toilet may also be a factor. Certain drugs such as painkillers may trigger constipation. The hormone changes of pregnancy may also predispose to constipation. Fissures may also occur in children and very young babies.

Treatment Involved for Anal Fissures

In the acute stage, local anaesthetic creams and suppositories may produce some relief. This is combined with a laxative to soften the motion and ensure a regular bowel action. Ointments to relax the muscle of the back passage may also be given to you. If the condition is extremely painful, or becomes chronic, surgery may be advised. This is performed under general anaesthetic. An anal stretch operation (stretching the muscles of the anal canal) overcomes the spasm and temporarily paralyses the muscles. This gives the tear an opportunity to heal. If the fissure is long-standing, it may be cut out (excised) to encourage healing. The operation of lateral sphincterotomy involves a small cut in a part of the muscle of the anal canal. This again relieves the spasm and redistributes the strain within the anal canal away from the fissure, giving it the opportunity to heal.

During Treatment for Anal Fissures

An acute fissure should respond to the use of ointments and suppositories and bowel regulation within 2 weeks. If the laxatives prescribed are ineffective in producing a soft motion, they should be changed and the doctor consulted. Ointments given to relax the muscle cause headaches in some people. These do not usually last long, but may be severe enough to limit their use. Following the surgical procedures, you may find that you have a temporary inability to control the passage of wind. This will gradually improve over the subsequent weeks. During this period there may be minimal soiling of underclothes and it may be advisable to keep a local dressing over the anus. Twice daily baths help to keep the area clean and will prevent irritation. A simple non-perfumed soap should be used.

After Treatment for Anal Fissures

The main problem would be increasing pain and constipation. A chronic fissure may also act as a tract through which small amounts of faeces can make their way to the skin around the anus. This can cause irritation and inflammation of the skin, and occasionally an abscess may result. Constipation must be avoided by an adequate intake of fibre, supplemented by laxatives if necessary.

If Anal Fissures are Left Untreated

Once the fissure has healed, attention must be paid to keeping the consistency of the motion soft, and the avoidance of constipation. The correct choice of laxative, or alteration of diet, should be discussed with your doctor. Generally, strong purgatives should be avoided.