An anal fissure is tearing in the lining of the anus. It can cause pain, bleeding and/or itching.
It is usually caused by a hard and dry bowel movement which tears the anal lining. Other causes include diarrhoea and inflammation of the anorectal area.
When healing starts after a tear, the area is not as healthy as normal lining. Another episode of hard stools will cause the healing area to tear again. Repeated tearing will result in the tear becoming deeper and deeper. When the muscles of the anus lying below the lining are exposed, the muscles go into spasm. This results in more pain, and as the muscle is tight, stronger force is required to push the stools through and this result in more tearing. In these cases, the relaxation induced by the glyceryl trinitrie ointment is inadequate to allow good blood flow for healing.
A fissure that does not heal should be re-examined to determine if an underlying problem that prevents healing exists. This could be due to scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding can be corrected by anal surgery.
Most patients can go home the same day. Complete healing occurs in a few weeks, although pain often disappears after a few days.
Most patients who had anal surgery for anal fissure have no further trouble after surgery.
No! Persistent symptoms need careful evaluation, however, since conditions other than fissure can cause similar symptoms.