Anal Fissures

Anal fissures are very common. A fissure can be thought of as a cut in the anal skin. Because there is no tissue between the skin and the muscle of the internal anal sphincter, a cut in this skin actually exposes the muscle. This is very irritating to the muscle and induces the intense sensation that is felt after a bowel movement. Because there is a break in the skin, bleeding is common. A bowel movement will often reopen the wound causing bleeding and discomfort.

The initial treatment is to form a stool that will pass with a minimum of stretching of the anal skin, sometimes allowing the fissure to heal. 0.2% Nitropaste ointment aids this healing. This should be applied with a cotton-tipped applicator in the morning, before bed, after a bowel movement, or if the pain grows severe. This ointment works by relaxing the anal sphincter muscle. The common side effect from Nitropaste is headache that occurs when too large of a skin area absorbs the medication. This is the reason it is applied with a cotton-tipped applicator. Too much medication is absorbed through the fingers if applied directly, often causing a headache. Occasionally, headache occurs despite proper application. You should call and discuss this with the doctor if it occurs to you.

Dietary changes are recommended. Water, juices and soups are helpful towards a soft stool, because a percentage of these fluids stay in the stool and keep it soft. Commercially promoted liquids such as coffee, tea, caffeinated soft drinks, and alcoholic beverages actually are eliminated mostly in the urine and can actually cause dehydration and hardening of the stool. These liquids should be consumed sparingly and replaced by water and juice in the diet. High fiber foods such as bran cereals, instant oatmeal, beans, peas, corn, bananas, apples and other fresh uncooked fruits and vegetables should be taken liberally. A commercially available fiber supplement should also be taken at least once a day.

Unfortunately, in some of the patients affected, although symptoms improve with this stool softening method, the fissure either persists or recurs after a time. At this point surgery is recommended.

The procedure performed cuts about half of the width of the internal anal sphincter muscle. This allows the anal canal to widen at its outlet and relieves the spasms that occur after a bowel movement. This procedure has been noted to allow the fissure to heal in almost all patients who undergo the procedure. The procedure can most often be performed on an outpatient basis. Complications are uncommon, but can occur after surgery. Bleeding may occur soon after or within two weeks after surgery. Uncommonly this bleeding may be severe. Infection is uncommon. Other patients have reported that control of the bowel movements, especially the passage of rectal gas is weaker after surgery. In most cases, control returns close to normal within several weeks after surgery. Most patients heal well within three weeks and have no lasting effects after surgery. Many people feel they can return to their usual activities within days after the procedure although strenuous activity should be avoided until the surgical wound and the fissure completely heal.

You should discuss any concerns that you have with the doctor.