Anal Fissure

Anal Fissure is one of the most common pathologies of the anus. An Anal Fissure is a small tear in the tissue inside the anal margin of the anal canal, and although small ( usually less than 1cm), it is very painful and can cause a sphincter muscle spasm that may last several hours.

Anal Fissure can affect people of any age (it is the most common cause for anal bleeding in children) but it is most commonly found in young adults. It affects both genders equally and is usually located posteriorly on the midline of the anus (The 6 o´clock position).

It is not yet clear what actually causes an anal fissure, but it is known that trauma to the anal canal due to constipation and the passing of hard stool is often the triggering factor. Small anal fissures may heal spontaneously but some persist and become chronic. It is believed that fissures tend to persist in people that have an inner sphichter muscle that is more contracted ( higher anal pressure )than that of people whose fissures heal spontaneously.

Síntomas

The most characteristic symptom of anal fistula is severe pain during and after bowel movement

The pain may last several hours. Pain may also be experienced when coughing, sneezing or passing air. Some patients avoid going to the toilet out of fear, which leads to constipation and unfortunately makes the next visit to the toilet even more painful. (because the stool is then is harder and larger) .

Bleeding is common but it is usually mild. The blood is bright red.

Many patients also have a small lump of skin next to the tear on the outside border of the anus. This lump is called a tag, and it is often mistaken for a hemorrhoid (even by doctors). The skin is swollen and hard and the tag confirms the presence of a fissure.

 

Diagnosis

Anal fissures can usually be diagnosed based on the symptoms described by the patient.

Physical Examination

Anal examination may confirm the diagnosis, but because it is extremely painful, WE DO NOT PERFORM A PHYICAL EXAMINATION ON FISSURE PATIENTS!

It does not make sense to cause intense pain and needless suffering by intoducing a rectoscope or a finger in the anus of a patient (this practice is very common) who has come to us precisely because this pain is making his life unbearable. What we do to confirm the diagnosis is to gently separate the buttocks, allowing us to see the fissure. The patient can then be treated for anal fissure and a complete examination can be carried out free of pain 2 or 3 weeks after the treatment has been completed. .

Treatment

In our Practice we see many patients that have been treated elsewhere for their fisssures but without success: Nitroglycerine ointments, anaesthetic injections around the fissure, botulinum toxin, stool regulators and other treatments seldom lead to healing of the fissure, but are often recommended instead of surgery, for fear of anal incontinence.

I have been treating patient with anal fissures since 1980. After having treated approximately 1500 patients I can confidently say that SURGERY IS THE TEATMENT OF CHOICE FOR ANAL FISSURE

Surgery takes place under anaesthesia mostly a deep sedation (spinal or epidural can also be used ) and patient may return home after 6-8 hours. Patients will be free of pain and may return to their daily activities 24-48 hours after surgery. Anal fissure surgery is very gratifying for both surgeon and patient. If the surgery is properly performed by the surgeon, there is no risk of anal incontinece for the patient.

    The surgical technique we apply is called Lateral Subcutaneous Internal Sphincterectomy (with CO2 laser since 1993)

    The technique involves making a 3mm incision lateral to the anus and then using the CO2 laser to perform a small cut on the internal anal sphincter muscle. This permanently reduces the tone (tension) around the anus, allows the fissure to heal and relieves pain completely.

       

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