Colorectal (Bowel and Anal conditions)

Conditions Treated

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What is an Anal Fissure?

An anal fissure is a tear in the skin around the anus.  It can be terribly painful when passing a bowel motion, and the pain can last for some time after the motion has passed.  It can cause also bright red bleeding from the back passage.

It can be caused by passing a large, hard motion, where the skin of the back passage has been stretched.  It can also happen if you are passing loose, frequent bowel motions, where the skin becomes fragile and weak.

Can fissures heal without treatment?

Superficial tears can sometimes heal in a couple of weeks.  However, what can happen, is that the muscle that keeps you continent, the anal sphincter, can go into spasm due to the pain.  This results the blood supply to the skin of the anus, being reduced.  If the blood supply isn’t good, the skin then fails to heal properly.  The fissure then becomes a chronic problem that can be miserable to live with.

What treatments are there for anal fissures?

The most common treatment is a cream called GTN, or another agent called diltiazem.  They are used on the skin of the anus twice a day for 8 weeks.  We would also prescribe a laxative to make sure that your motion is soft and easy to pass. The creams increase the blood supply to the skin around the anus and we can often get the fissure to completely heal.

If the fissure is still causing symptoms after this time, my practice would be to do a small day case procedure, under an anaesthetic.  During this operation, I would inject botox into the muscle of the back passage.  This has the effect of reducing the spasm in the back passage, allowing a good blood supply to get to the anal skin, so that it will heal.  This procedure can be repeated if the fissure recurs.

Rarely, these measures fail, and then I would discuss the other options available.

What should I do if I think I have a fissure?

If you have symptoms of pain or bleeding from your back passage, it is totally appropriate to see your GP, so you can be examined.  Your GP can start first line treatment, if they are able to see an obvious fissure.  If it isn’t obvious what the cause of your symptoms are, then your GP will refer you to a specialist, like myself, for further investigation and treatment.  Your GP can also refer you to a specialist, if first line treatment has failed.