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Anal Fissure

Anal Fissure

An anal fissure is a small tear or cut in the skin that lines the anal canal. Each time stool passes through the anal canal, the tear opens causing an ulceration that results in pain and bleeding with bowel movement. Patients often report sensation of passing glass with bowel movements. Anal fissures can sometimes bleed heavily.

Anal fissures are most often associated with a history of constipation as passing large, hard stools can tear the anal lining. However, patients with chronic diarrhea, laxative abuse, poor diet, previous anal surgery, or history of childbirth can also develop anal fissure.

Treatment of Anal Fissure

Treatment for anal fissure is targeted at normalizing daily bowel pattern. First line therapy for anal fissure is increasing fiber and water in your diet and soaking in warm baths several times per day. Soaking in warm baths helps increase blood supply to the area and promote relaxation of the anal muscle, thus promoting the fissure to heal. Additionally, you may be prescribed a topical cream to further aid in anal muscle relaxation. Common creams for anal fissure include nifedipine or diltiazem ointments. Once the fissure is healed, it is important to continue a healthy pattern of daily bowel movements to prevent the fissure from reoccurring.

Anal fissures that fail to respond to conservative treatment may require surgical intervention. Additional treatment options for anal fissure may include Anal Botox or surgery on the anal muscle called a Sphincterotomy. Anal Botox is performed as an outpatient procedure and can temporarily relax the anal muscle thus allowing the fissure to heal. Sometimes, repeated Botox is needed. Anal Sphincterotomy is a highly effective treatment for anal fissure and recurrence rates are low. Anal Sphincterotomy consists of cutting a portion of the anal sphincter muscle to relax and open the area. Surgical treatments do have their risks and advantages and it is important to discuss them in detail with your provider. 

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