Anal Fissure

What is Anal Fissure?

An anal fissure is a tear in the skin around the back passage. It is a common problem that can cause severe pain especially after a bowel movement. It may also cause bleeding.

The condition is associated with spasm of the internal anal sphincter. This reduces the blood supply to the skin in the anal canal and prevents healing. The treatment is aimed at breaking this cycle to allow healing to take place.

Anal fissures can be excruciatingly painful. They are a common cause of anal pain and usually patients describe severe pain especially when passing stool and describe the pain as ‘passing razor blades’. The pain can persist for a while after going to the toilet.

Treatment for Anal Fissure

Topical creams:

The first line of treatment is with topical creams which should be used regularly for six to eight weeks even if the symptoms disappear after the first weeks of treatment. Rectogesic (Glyceryl Trinitrate) and Anoheal (Diltiazem) are similar in their efficacy and should be applied wearing gloves at least a couple of times a day for six weeks. These topical treatments are usually very effective and they will heal about 60-70% of fissures. If they fail to work alternative surgical treatments may be suggested.

Botox injection

Botox injection has gained popularity for treating this condition. Botox is injected close to or into the internal sphincter muscle. The injection works by causing the muscle to become partially paralysed and thereby reducing the amount of spasm or contraction that it undergoes in conjunction with a fissure. This enforces relaxation and allows more blood flow to the area to help heal the fissure. Botox lasts in the system for between eight to twelve weeks. This will usually allow the fissure enough time to heal. It is usually well tolerated and does not always affect continence but does require the procedure to be performed under a general anaesthetic. This will also allow the surgeon to examine the patient more thoroughly which may be too uncomfortable in clinic.

As it is well tolerated patients who fail to heal on the first injection may often be offered repeated injections in an attempt to heal the fissure. If the fissure still continues to be a problem despite repeated Botox injections, then two further procedures may be considered. Due to the temporary weakening of the muscle from the Botox injection, some people do experience a degree of urgency going to the toilet following injection of Botox although this is temporary as the Botox wears off.

Advancement flap

A special type of procedure called an advancement flap can sometimes be used to remove the fissure and to advance healthy tissue over the excision site which is then sutured into place.

Lateral sphincterotomy

The other alternative is a lateral sphincterotomy. This is where a targeted cut is made in the muscle under general anaesthetic and is usually done under ultrasound guidance. The length of muscle being cut usually correlates to the length of the fissure and great care is taken not to cut too much of the muscle as this can render it permanently weak and lead to weakness, urgency and sometimes incontinence. It is because of this side effect that it is used as a last resort, although it usually does have very good rates of healing fissures.

Basingstoke Colorectal
The Hampshire Clinic
Basing Road
Basingstoke RG24 7AL

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01256 354747