Anal Fissures

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Anal Fissures: aka  Anal Tears, Rectum Tears, Rectum Lining Tear




What Is It?


An anal fissure is a tear or sometimes an ulcer that occurs inside the lining of the rectum or anal canal. This is the very end part of the rectum that you cannot see. Fissures can occur anytime, anywhere but are most common in adults that are middle age and in younger adults. Often anal fissures heal well alone but sometimes this can’t occur because the anal muscle spasms. 


Among the signs and symptoms of anal fissures include red blood appearing in the toilet and on paper and having painful bowel movements. Typically a doctor will diagnose anal fissures using a special instrument known as a sigmoidoscope or by visual examination. Typically a doctor will want to confirm a diagnosis before recommending treatment. He or she will want to rule out other causes for symptoms including heroes. Many different causes can result in anal bleeding. Anal fissures typically result from Crohn’s Disease or chronic constipation.




The Operation


Patients with severe fissures that do not heal on their own may require surgery, either an anal dilation or a lateral internal sphincterotomy (also known as an LIS). The dilation is not used as often because it can cause incontinence or the inability to control one’s bowels.
The LIS surgery is performed under general anesthesia. Most patients can have this surgery done in one day on an outpatient basis. During the procedure the doctor will cut a small part of the muscle of the anal canal. This should relieve spasms occurring in the sphincter muscle, which will allow the fissure to heal. This cures anal fissures in a majority of patients that have the procedure.




Alternatives to Surgery


Often simply relieving the pressure on the anal canal and rectum can help alleviate the pain associated with an anal fissure. Treatment goals include softening the stool to help pass stool along and minimize discomfort including bleeding. Among the recommendations that do not involve surgery include:


  • Taking warm baths also known as sitz-baths where a patient sits in a small tub filled with warm water.
  • Eating foods that help promote soft stools including fibrous vegetables and fruit.
  • Taking stool softeners when recommended by a doctor or other healthcare provider.
  • Using a lubricant to help bowels pass easier.
  • Trying topical agents to help relieve pain.


Some doctors are also trying chemical agents like Botox injections to try to relieve anal fissures, because these relax the sphincter muscles which may allow the fissure time to heal. These injections may work better than other topical agents like nitroglycerin, which has a similar action.




Before The Operation


Before the surgery a patient will be asked to try many other types of therapy in an attempt to control spasms and heal the fissure without surgery. If this fails the patient will be asked to prepare for surgery by avoiding foods for 8 to 12 hours before the procedure.




After The Operation


Most patients can go home on the same day. You will first go to a recovery room where you can rest for up to 2 hours. At home it is important the wound remain clean and dry; most healthcare providers recommend using a moist towlette not paper to wipe.




Possible Complications


Generally healing anal fissures is not complicated, and neither is the LIS surgery doctors use to cut the sphincter muscle to allow for faster recovery. Most patients are at greatest risk for a possible infection, or for tearing the wound even more by not following their doctor’s advice. If you strain during bowel movements you are always at risk for anal fissures and hemorrhoids. You should consider using a stool softener and talking with your doctor to rule out causes for constipation.




General Advice


Anal fissures area relatively common occurrence. These uncomfortable tears in the anal muscle generally heal on their own after several weeks. Some people find however they need surgical intervention to help heal the fissure. If this is the case you can have a special procedure performed that will help relax the anal sphincter so your fissure can heal. It is important to keep this area clean and dry following the procedure and to avoid straining during bowel movements.


The success rate for LIS surgery is very high. Most people with fissures heal well using non-invasive techniques.




Estimated Costs for Anal Fissures


Country Costs
USA $3,000-$8,000
Malaysia $1,000-$1,500
Singapore $1,500-$2,900
India $900-1200
Thailand $1,200-$1,500

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