- Anal Fissure
What is Anal Fissure?
Anal fissure means a skin tear in the anal canal. It is a common anal disease. It mostly happens in midline posteriorly or anteriorly. Anal fissure can be classifed as acute anal fissure, chronic anal fissure, and secondary anal fissure. Acute anal fissure means the tear in the superficial skin of anal canal. In chronic anal fissure, the whole skin layer of anal canal is torn and the underlying sphincter is often exposed. Sometimes anal fissure occurs as a complication of Crohn's disease, poor wound healing formed after anal surgery, called secondary anal fissure.
Acute anal fissure anal skin shallow cracked. Chronic Anal Fissure anal full-thickness skin split, the formation of chronic ulcers. Secondary anal fissure Crohn's disease, anal after surgery (hemorrhoidectomy or fistula incision) poor wound healing formed.
Anal fissure is mainly caused by constipation or hard feces. In bowel opening, patients feel pain when hard feces cut the anal skin and cause the fissure. When there is pain, the internal anal sphincter contracts vigorously. The elevated resting level of contraction results is less blood flowing to inner anal tissue, and thus poor healing of anal fissure.
If there is a tear in the anal skin, our body will attempt to heal the tear. Scar tissue will grow around the fissure, causing the formation of inflammation and connective tissue, naming hypertrophic papilla and sentinel pile.
Main clinical symptoms
Symptoms include pain during and after bowel opening, bleeding during and after bowel opening, constipation, hard stool, and anal itchiness after bowel opening. Some patients have diarrhea.
Anal clinical examination
- Anal inspection - external observation if the anus
- Digital Rectal examination - Doctors use a gloved digit to palpate the anus and rectum.
- Proctoscope and Anoscope examination - Doctors use an proctoscope/ anoscope to have visual examination of the lower rectum and anal canal.
- Anal Fissure Treatment
Anal Fissure Treatment
Anal Fissure Treatment can be processed at hospital or clinic
Acute Anal Fissure
Acute Anal Fissure Treatment:
- Soaked in warm water: soaked in 40°C water, to lower the anal pressure
- Develop a good diet habit and bowel habits
- Oral medication: stool softener
- Use ointment with the following effect: local anesthetic/ anti-inflammation/ antibiotic/ lubrication
Chronic Anal Fissure
Conservative management is unlikely to be successful. Options:
- Botulinum toxin sphincter injection is recently studied and found that some of the chronic anal fissure can be healed by botulinum toxin.
- Lateral internal sphincterotomy cut and relax the lower part of the internal anal sphincter. The resting pressure of the internal anal sphincter is lower. The blood supply of the chronic anal fissure is better.
- Use electrocautery to stop bleeding from the edge of the chronic anal fissure - Remove sentinel pile and hypertrophic papilla
- The new lateral sphincterotomy cut wound and the chronic anal fissure usually heal in 3-6 weeks time.
- Clinical research found that Lateral internal sphincterotomy is more effective than botulinum toxin sphincter injection treatment in healing chronic anal fissure.