Anal Fissure

What is a fissure?

An anal fissure is a split in the skin at the anal opening (verge). The split fails to heal and forms a chronic wound that leads to a spasm pain due to contraction of the sphincter muscle.

What is the cause of a fissure?

Most fissures are caused by local injury/trauma to the anus. Most often this is due to passing a hard bowel motion. Usually, the split in the skin will heal by itself. Sometimes, the split fails to heal and leads to a chronic fissure.

What are the symptoms of a fissure?

The wound leads to spasm of the underlying sphincter muscle. This causes an intense anal pain, especially after passing stool. The wound may also lead to bleeding especially on the toilet paper and occasionally an itch or discharge. Often, a swollen lump known as a skin tag will develop.

What is the treatment?

Many fissures can be healed with medical treatment. This involves a combination of stool softners, high fibre diet and topical treatment (creams) aimed at treating pain and relaxing the sphincter muscle.
Sometimes, the fissure does not heal with medical treatment. Surgical treatment options include botox injection, removing the fissure and closing the skin with a small flap, and dividing some of the sphincter muscle (lateral internal sphincterotomy). Your surgeon will explain to you the options and the risks and benefits of each treatment.

What are the results and complcations of surgical treatment?

The results of surgery are good. Healing may take many weeks but usually the pain should be better following surgery. Healing of the fissure can be expected in 75% of patients after Botox injection and 95% of patients after sphincterotomy. Complications are very uncommon. Following surgery, some patients will have some impairment in the ability to control wind. This will usually recover approximately 3 months after Botox but may be longer lasting after sphincterotomy. Incontinence to faeces is a very rare complication of surgery.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.