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ANAL FISSURES Facts

An anal fissure is a small tear or cut in the skin lining the anus which can cause pain and/or bleeding.

What are the symptoms of an anal fissure?

The typical symptoms of an anal fissure are extreme pain during defecation and red blood streaking the stool. Patients may try to avoid defecation because of the pain.

What causes an anal fissure?

A hard, dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the anorectal area.
Anal fissures may be acute (recent onset) or chronic (present for a long time or recurring frequently). An acute fissure is usually due to altered bowel habits while a chronic fissure may be either due to poor bowel habits, overly tight or spastic anal sphincter muscles, scarring or an underlying medical problem.

How can a fissure be treated?

An acute fissure is managed with non-operative treatments and over 90% will heal without surgery. Bowel habits are improved with a high fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids to avoid constipation and promote the passage of soft stools. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles. Occasionally, special medicated creams may be recommended. A chronic fissure (lasting greater than one month) may require additional treatment. Depending on the appearance of the fissure, other medical problems such as inflammatory bowel disease or infections may be considered and testing may be recommended. A manometry test may be performed to determine if anal sphincter pressures are high. An examination under anesthesia may be recommended to determine if a definite reason exists for lack of healing.

What can be done if a fissure doesn’t heal?

A fissure that fails to respond to treatment should be re-examined to determine if a definitive reason exists for lack of healing. Such reasons can include scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding can be corrected by surgery.

What does surgery involve?

Surgery usual consists of a small operation to cut a portion of the internal anal sphincter muscle. This helps the fissure to heal by decreasing pain and spasm. Cutting this muscle rarely interferes with the ability to control bowel movements and can usually be performed without an overnight hospital stay.

How long does the healing process take after surgery? Complete healing occurs in a few weeks, although pain often disappears after a few days.

Will the problem return?

More than 90% of patients who require surgery for this problem have no further trouble from fissures. If the problem returns without an obvious cause, the person may need further assessment including anal manometry testing or an exam under anesthesia.

Can fissures lead to colon cancer?

No! Persistent symptoms need careful evaluation, however, since conditions other than fissure can cause similar symptoms.

What to ask your surgeon about surgery

Yes. In fact we are double board certified by both the American Board of Surgeons as well as the American Board of Colon and Rectal Surgeons.

Yes – We routinely perform several laparoscopic colon procedures each week.

Our surgeons have performed over 500 laparoscopic colectomies since 2004 which makes us one of the highest volume practices in the country.

Among the benefits, our patients recover sooner, require less pain medication, tolerate a diet and are discharged from the hospital earlier than patients undergoing open surgery.

Nearly all patients are candidates for this procedure – even if you have had previous open abdominal procedures or have many medical diseases.

As with any colon or general surgery there are several potential risks which we will discuss with you on an individual basis. However, we have seen significantly fewer risks with our patients following laparoscopic surgery – including a much reduced risk of wound infections.

This refers to the situation where you begin the surgery laparoscopically and must convert to the open technique for various reasons. Our rate of conversion is less than 5%.

Most of our patients are ready to leave the hospital in 3 or 4 days following surgery. This compares favorably to open surgery which usually requires 7 to 9 days.

Yes. Houston Colon surgeons maintain a prospective patient database which allows us to review and present our patient outcomes. We recently invited to present our data at TexMed 2006 – the annual meeting of the Texas Medical Association. Our outcomes have been very favorable with very low complication rates and compare well with published data from the Society of Colon and Rectal Surgeons.