If the answer is yes, it is most likely due to a condition called an anal fissure. An anal fissure is a longitudinal ulcer in the anal canal. It is one of the most common medical problems encountered by doctors. Patients usually complain about pain and bleeding during the passage of stools. Pain subsides after some time and recurs again the next time stools are passed.
The fissure pain can be acute or chronic. The acute condition usually heals in 4 to 6 weeks. The chronic fissure continues to produce symptoms beyond this period. They are associated with constipation but may also occur due to diarrhoea. Patients may also complain about itching around the anus.
Common facts about anal fissures
The fissure is usually located in the midline, posteriorly (behind) or anteriorly (front). Anterior fissure is more common in females and is related to trauma of vaginal delivery of a baby. A typical fissures can be located anywhere and are associated with other diseases like Crohn’s disease, tuberculosis, cancer, human immunodeficiency virus infection and syphilis. A biopsy is done to confirm the diagnosis in chronic cases or when the fissure is located in atypical position.
An anal fissure is a common disorder that is effectively treated and prevented with conservative measures in its acute form. Chronic fissures usually require medical therapy. Treatment is required for the relief of pain and bleeding. The two methods of treatment are medical and surgical. The medical method involves local applications and injections.
Medical treatment of anal fissure pain
The conservative treatment is usually the first approach. It involves the following methods:
- Stool softeners or lubricant laxatives like liquid paraffin and lactulose. They help in easy passage of hard stools.
- Bulk laxative like isabghol is added in chronic cases. The fiber content helps in relief of chronic constipation.
- Sitz bath – a warm water hip bath helps in keeping the area clean. The warmth also improves the blood flow and reduces spasms of the anal sphincter to provide pain relief.
- Topical anaesthetic like 2% lignocaine jelly is applied with a nozzle locally, few minutes before the act of defecation. It provides pain relief and is symptomatically soothing.
- Calcium channel blockers – Nifedipine and Diltiazem ointment used topically result in relaxation of the anal sphincter. It reduces pain and heals the fissure.
- Botulinum toxin type A – On local injection, it reduces sphincter spasm which lasts for 2 to 4 months. This results in healing of the fissure. The popularity of botulinum toxin is increasing rapidly.
Surgical treatment of anal fissure pain
Sphincterotomy is usually done on failure of medical management. The internal sphincter of the anal canal is divided under local/regional anesthesia. It results in relaxation of the sphincter which is followed by pain relief and healing of the fissure.
An anal fissure is a severely painful condition which may result in long term pain and blood loss during passage of stools. It can be managed both medically and surgically. If you have any of these symptoms, consult your doctor before it becomes chronic.
Dr. Uday Singh Dadhwal
(Specialist General Surgery)
Bahrain Specialist Hospital
Email: uday.dadhwal@bsh.com.bh