What is an anal fissure?
A fissure is a small tear at the anal canal. It is a very common cause of anal pain during bowel motion.
What are the symptoms?
The commonest symptom is pain. There is a tearing pain during bowel motion with spasm pain well after the motion. There is minor bleeding. If there is more bleeding it is probably due to concomitant internal haemorrhoids.
What a causes a fissure?
The commonest cause is passage of hard stools (constipation). It can also be caused by diarrhoea and frequent cleaning of the anal canal. There are some diseases such as Crohn’s disease and infections that can cause fissures as well.
What is the treatment?
The initial treatment will be stool softeners and increase water intake. There are topical creams that work very well. The most common cream is Rectogesic, which can be bought over the counter. If this fails there is a very effective operation called a lateral anal sphincterotomy.
What is Rectogesic?
This is a cream that relaxes the anal sphincter and increases the blood flow to the anal canal, which thereby reduces pain and improves healing. It is quite successful with a 7 out of 10 patients having good resolution of symptoms. The cream can be used again if there is recurrence.
It is a very safe medication and can be used during pregnancy and lactation. It can cause headaches and light-headedness. If this occurs then there are several things that can be done. Firstly use a smaller amount of the cream. Apply the cream wearing a rubber glove and regular use of simple painkillers such as paracetamol is also helpful. If the side effects persist, other treatments such as surgery may be required.
Can the fissure come back?
The fissure can come back if there is ongoing constipation. It very rarely recurs after surgery, which has by far the best results.