An anal fissure is a break in the lining of the anal canal that can cause acute anal pain and bleeding. A fissure is commonly started following a bout of constipation. The symptoms commonly worsen following bowel movements. The pain usually starts immediately following a bowel movement and can persist for a coupe of hours following this. The bleeding is usually noticed on wiping and may appear as a streak on the toilet paper.
Medical Management of Fissure
Sometimes an anal fissure can settle down and improve without the need for medical intervention, or with the use of some mild laxatives. Should this not improve symptoms, then the use of creams applied to the anus, such as Rectogesic or Anoheal, can be used. These creams are effective if used regularly for a 6 week period, but the main side effect of headaches can lead to some patients stopping their use prematurely.
Surgical Management of Fissure
For chronic (persistent) anal fissures, or acute anal fissures causing severe pain, then surgery may be required. Surgery usually involves cleaning the base of the fissure (fissurectomy) combined with either injection of Botulinum toxin (Botox) into the anal muscles or surgical division of one of the anal muscles. This is known as a lateral sphincterotomy. These procedures can lead to some difficulty in controlling the passage of wind, and may rarely lead to incontinence to stool. If this occurs following a Botox injection, it normally improves as the effects of the drug wear off (around 2 – 3 months).