The anal fissure is a small fissure, crevice or superficial lesion, located on the wall of the anal canal (at the base of the rectum). It occurs frequently in adults. It can be associated with repeated constipation, hard stool, diarrhea or more rarely, inflammatory bowel disease or certain sexual practices, such as sodomy. Anal fissures are also common in babies 6 months to 2 years old but rare in older children.
The anal fissure causes sharp pain and light bleeding, especially at the time of bowel movement. In the vast majority of cases, they can be resolved without surgery.
Many patients are reluctant to see a doctor because they are embarrassed to discuss their symptoms. Pushing back the treatment can, however, in the long run, create an apprehension to go to the saddle. This apprehension can cause constipation and the expansion of the tear. Thus begins a vicious circle.
When they do not heal properly, cracks can become chronic. They can eventually affect the sphincter muscles, causing painful spasms.
When to consult?
A medical consultation is recommended when home treatment does not provide relief.
Symptoms of anal fissure
- Pain sometimes very intense, often burn type especially at the time of passing stool. Once the stool has passed, typically, the pain decreases, and then it tends to return within hours.
- Traces of blood on the surface of stools or on toilet paper;
- Itching in the anus, often outside the episodes of intense pain, which can lead to scratching lesions;
- Anal contracture due to muscle spasms of the anal sphincter;
- Reflex constipation for fear of pain.
- The Age. Babies under 2 years old often suffer from anal fissures for some unexplained reason.
- Repeated seizures of constipation. Forcing and evacuating hard and bulky stools is probably conducive to anal fissures;
- The childbirth. Women are more likely to suffer from anal fissures in this period of life. They should not be operated, but treated medically, and in case of fissure becoming chronic, the surgery can be considered only 6 months at the earliest after a delivery.
Prevention of anal fissure
The risk of anal fissures can be reduced by preventing constipation:
- Focus on foods high in dietary fiber, such as whole grains, pulses, fruits and vegetables, and if necessary, take a mass laxative in case of constipation (psyllium, Metamucil, etc.) to soften the stool.
- Drink enough;
- Regular physical activity
- Go to the saddle as soon as the need is felt and avoid forcing.
Medical treatments of anal fissure
The treatments are aimed at relieving pain and anal spasms, and healing the fissure.
Basic preventative measures heal half of the acute anal fissures.
– Consume enough fiber,
– Drink enough, be physically active,
– Avoid constipation, do not force while having a bowel movement),
– Take a sitz bath for 10 to 15 minutes, 2 to 3 times a day, will relieve pain and itching.
– Sink soap and scented toilet paper as this may increase irritation.
– Use mild (non-irritating) laxatives such as mucilage, osmotic laxatives, or lubricants.
– Healing preparations based on vitamins or anti-inflammatories are available in pharmacies, but these treatments have not shown superior efficacy compared to a simple lubricant.
– Suppositories lubricating the anal canal and facilitating stool passage may be helpful
– Paracetamol or an anti-inflammatory can relieve pain.
Medical treatments of an anal fissure
In addition to basic treatments, doctors prescribe treatments to act on the cause of anal fissures when they become chronic because of a large part of hypertonicity of the anal sphincter.
– Nitrate derivatives such as glyceryl trinitrate (Rectogesic) are effective against pain and improve healing at the dose of an application morning and evening for a month and a half. However, this type of treatment is often associated with headaches caused by systemic absorption of the drug.
– Calcium inhibitors are sometimes also prescribed. But these drugs do not currently have an official indication.
– Botulinum toxin (Botox, Vistabel, Dysport, Xeomin or Neurobloc) can be injected into the sphincter to relax the contracture muscles. By paralyzing the muscles, the toxin calms spasms and promotes healing. It is effective, but officially, the indication is not recognized in France for this type of treatment. However this can avoid the need for surgery.
If the symptoms have not disappeared after 6 to 8 weeks of treatment, surgery may be necessary. It is the most effective treatment for chronic anal fissures. The procedure called sphincterectomy, involves cutting some of the sphincter muscles to stop spasms and promote healing. The intervention is usually done in outpatient surgery, without hospitalization. It heals in a few days. The risk of permanent anal incontinence after surgery is minimal but up to 45% of patients have slight anal incontinence in the days following surgery.