Anal Fissures

An anal fissure is a small tear in the skin just within the anus. Despite the small size of the tear, the pain felt can be significant.

Most people who develop an anal fissure will feel a bit sore for a few days, but it will then heal naturally. Other people will find that it just doesn't heal. After six weeks, it becomes unlikely it will heal by itself; this is known as a chronic anal fissure or chronic fissure-in-ano

Symptoms

An anal fissure can cause a lot of trouble for some people. Whilst some find it more of a nuisance than anything else, experiencing only a bit of discomfort whilst opening their bowels, others find they get quite a significant ache in their anus for 30 - 90 minutes during and after a bowel action. Although it is unusual, at the most extreme, some people may experience pain for hours, or even all day, every time they go to the toilet.

Probably the vast majority of the people who come to see me for help complain about how much of a nuisance it is. Often, they will have started laxatives to try to help reduce the pain they feel when they go to the loo. Laxatives may have been initiated by the patient or their GP.

Treatment

The good news is that there are some helpful treatments available to stop the pain and to treat the fissure. These are both non-surgical (conservative) and surgical, with surgical being used for the most severe cases where non-surgical options have failed.

Your GP may have started some form of conservative treatment before referral, and this is always helpful.

The three main treatments are:

Ointment: These are not the over-the-counter ointments typically used to treat haemorrhoids. They must be prescribed and there are two versions of ointment (GTN or diltiazem based), both of which are applied to the anus. They can help to relax the muscle, reduce the spasmodic pain, improve the blood supply and lead to healing in up to 40% of patients with a six-week course of twice daily application. I always let people know that one of these creams (GTN) can cause a bit of a headache at first. Some people may find it is too uncomfortable to keep on applying, but it is a good option to try before anything else.

Botox injection: People always find one this quite amusing as they tend to associate it with cosmetic surgery! Botox is actually a very helpful treatment for treating anal fissures. Botox is injected into the muscle around the anus. Similar to the ointment, it relaxes the muscle to reduce spasm, improves the blood supply and can lead to healing in 60 - 80% of patients.

In America, this injection is normally done in a walk-in clinic, which can be quite uncomfortable. Here in the UK we tend to do it under general anaesthetic, which gives the added advantage of being able to freshen the edges of the chronic fissure and ‘kick-start’ the healing process again.

Surgery: Known as lateral sphincterotomy, surgery for anal fissures is performed as a day case under general anaesthetic and involves deliberately cutting the lower part of the anal sphincter. It is very effective, curing over 95% of fissures, but because we damage the anal sphincter a small proportion of people can experience minor loss of control of flatus or liquid stool (about 1 in 20 patients in studies). This side-effect doesn’t happen with the ointments or Botox and therefore, although lateral sphincterotomy is a better treatment, it is usually kept in reserve until other treatments have failed. In my experience, it tends to be the people with the worst pain who benefit the most from the sphincterotomy. Some of them notice the improvement soon after coming around from the anaesthetic.

Can I help?

If you have noticed any rectal bleeding and pain, you will understandably probably be quite concerned about what the cause might be. Your GP will be able to reassure you and online searches can sometimes be helpful but if you remain concerned my years of experience as a consultant surgeon could help you. I have treated many people who were struggling with an anal fissure. I have seen the difference that the correct treatment can make to the quality of their lives.

When you visit with me, we will spend time talking about you, your symptoms and your concerns. If it turns out that you do have an anal fissure, I can get treatment started to help get you out of pain.

It is very easy to book a consultation with me. Please contact my private secretary who will be delighted to schedule things for a time that is most convenient for you.