Anal fissures are spontaneous tears or wounds in the skin of the anal canal that appear with the passing of bright red blood from the anus, especially if the tear is acute, and are accompanied by intense periodic pain during defecation. However, in chronic cases, the severity of the pain is often reduced. Anal fissures usually extend from the anus and are typically located in the middle, likely due to the relatively unsupported nature of the anal wall in this area.
The fissure may be superficial or extend deeper under the sphincter muscle, and while it predominantly affects men, it can occasionally occur in women in rare instances.
Causes:
The most common cause of anal fissures is excessive stretching of the mucous membrane lining the anal canal. For example, fissures frequently occur in women after childbirth, following difficult bowel movements, during anal intercourse, or in infants after constipation.
Prevention:
• Avoid straining excessively during bowel movements, which includes treating and preventing constipation by consuming fiber-rich foods and drinking sufficient water.
• Maintain proper hygiene of the anal area after defecation.
Treatment:
Non-surgical treatment is generally the first approach for both acute and chronic anal fissures.
Common methods include warm sitz baths, topical anesthetics, fiber-rich diets, and stool softeners.
Surgical intervention may be necessary for chronic, deep fissures that do not respond to medical treatment. Although surgery has a high success rate (~95%), it is only considered after medical treatments have failed due to potential complications. These complications include: incontinence of the anal sphincter and inability to control gas, along with the risks associated with anesthesia. One of the most common surgeries for this condition is lateral internal sphincterotomy.
By Dr Emad Abd Al-Saheb
