Fissures are tears of the skin overlying the anus. They can be exceedingly painful and require months to heal. They occur because of over-stretching of the anal canal from hard stool or from objects inserted into the rectum. They fail to heal because of an increased tension in the muscle that does not allow the overlying skin to heal.
Diagnosis requires evaluation by an experienced physician who can make the diagnosis simply by looking at the anal area. Common complaints include excruciating anal pain that often follows each bowel movement and lasts for 1-2 hours before subsiding. Anal burning may also occur. Since a fissure is very similar to a paper cut on the skin, anything that irritates the area can worsen symptoms.
Treatment for Fissure
Treatment involves relaxing the muscle so that the skin is allowed to heal. Increased muscle tension may decrease blood flow to the skin and prolong the healing process. Various creams or ointments such as diltiazem or nitroglycerin applied to the area help to achieve this result. These creams are prescription only and require a specialized pharmacy that has to mix (or compound) them on site to make the appropriate concentration of drug. A numbing gel may also help symptoms while healing takes place. Increased fiber and increased fluid intake will avoid ongoing injury and constipation.
A second treatment involves injection of botulinum into the sphincter muscle. This is the same treatment used by Hollywood celebreties to decrease wrinkles and acts by paralyzing the muscle for several months. It is reversible and allows the skin to heal.
A third treatment involves surgery to physically cut the muscle. This results in the highest cure rates, the fastest resolution of pain. However, it is associated with a small risk of incontinence, which is why most patients prefer to try the other treatment strategies first. A discussion with your surgeon is required before proceeding with this option.
For more information on fissure, visit the American Society of Colon and Rectal Surgeons website.