What Is Anal Fissure (Rectal Tear)? Symptoms and Current Treatment Methods
What Is an Anal Fissure?
An anal fissure is a small tear or crack in the skin around the anus. It is typically associated with symptoms such as pain during bowel movements—often described as a sensation similar to passing glass—and bleeding. Acute fissures are superficial and short-term lesions that usually heal on their own within 4–6 weeks. Chronic fissures, on the other hand, are deeper, recurrent, and more difficult to heal.
What Happens in Chronic Anal Fissure?
In chronic cases, inflammation, scar tissue, skin tags, and hypertrophic papillae may develop on the surface of the anus and surrounding skin. These changes can lead to prolonged pain lasting 3–4 hours after a bowel movement.
Which Age Groups Are Affected?
Anal fissures can affect individuals of all ages—from infants to adults. However, they most commonly occur in young adults and middle-aged individuals. The incidence is similar in both men and women.
What Conditions Can Be Mistaken for Anal Fissure?
Anal fistulas, abscesses, Crohn’s disease, anal warts (HPV), rectal polyps, hemorrhoids, tuberculosis, and AIDS-related diseases can present with similar symptoms. Diagnosis should be confirmed by a skilled surgeon through physical examination. Underlying conditions such as chronic constipation or rectal disorders should also be investigated.
How Is the Diagnosis Made?
In most cases, visual inspection under adequate lighting reveals a single fissure located at the posterior midline of the anus. In rare cases, fissures can appear on different parts of the anus. If so, conditions such as Crohn’s disease, tuberculosis, syphilis, and AIDS should be ruled out.
When Should a Rectal Exam Be Performed?
Rectal exams using fingers are usually avoided in acute cases due to severe pain. However, they may be necessary to assess the depth of the fissure, evaluate the visibility of sphincter muscles, and examine accompanying lesions.
What Should the Diet of Patients with Anal Fissures Be Like?
To reduce constipation symptoms, it is essential to consume high-fiber foods (such as vegetables, fruits, and whole grains) and drink plenty of water. Spicy foods and fermented beverages should be avoided as they can irritate the fissure.
Which Sports Are Harmful? Which Are Beneficial?
Activities that apply pressure to the anal region—such as cycling, motorcycling, weightlifting, horse riding, and Pilates—may hinder the healing of fissures. On the other hand, swimming and thermal baths can support the healing process.
Can Anal Fissure Lead to Cancer?
No, an anal fissure does not turn into cancer. However, since it shares similar symptoms with rectal and anal canal cancers, it should always be evaluated by a medical specialist.
Does Every Anal Fissure Require Surgery?
No. Over 90% of acute anal fissures can heal without surgery. Preventing constipation and diarrhea, using sitz baths, topical anesthetic ointments, nitroglycerin, and calcium channel blocker creams can help relax the sphincter muscles and promote healing. Note that nitroglycerin creams may cause side effects such as severe headaches in some patients.
Botox for Anal Fissure Treatment
Botox® injection is an effective outpatient procedure commonly used in modern fissure treatment. It does not require general anesthesia, and patients can typically return to daily activities shortly after the procedure. When 30 Units of Botox are administered on either side of the anterior midline, it delivers high success rates with minimal systemic side effects.
Surgical Options for Anal Fissure
Lateral Internal Sphincterotomy
This is the gold-standard surgical procedure for chronic anal fissures. It works by relaxing the muscle to allow the fissure to heal. The success rate ranges between 94% and 100%. Although rare, post-operative gas or fecal incontinence may occur temporarily. The risk of permanent complications is very low.
Flap Surgery for Advanced Cases
In patients with weak anal sphincters or those with trauma from childbirth, flap surgery may be preferred over lateral sphincterotomy. This method involves reconstructing the fissure area and generally offers higher success rates, albeit with a longer recovery time.
Subcutaneous and Open Surgical Techniques
Surgical procedures for anal fissure can be performed using either an open or a closed (subcutaneous) technique. In the subcutaneous method, there may be technical risks such as the inability to locate the correct muscle accurately. All surgical procedures are typically carried out on an outpatient basis, and patients are discharged a few hours after post-operative observation.
Post-Surgery Care Instructions
- A diet rich in fiber
- Drinking at least 2 liters of water daily
- Establishing regular bowel habits
- Initial bathing with warm water or sitz baths
