Anal Fissure



The patients in Minnesota often couldn’t tell the differences between anal fissure and hemorrhoids. Although both hemorrhoids and anal fissure are associated with rectal pain and rectal bleeding, they are two very different diseases that are important to distinguish.

Hemorrhoids could be as painful as anal fissure when thrombosis develops. In the most time, the pain caused by hemorrhoids is mild, persistant, dull aching pain, not always related to bowel movement. Anal fissure usually has sharp rectal pain during bowel movements.

Anal Fissure
sphincterotomyAn anal fissure is a tear in the anal canal in the lower rectum. Anal fissures are typically thought to be caused by trauma from a hard or painful bowel movement, and are often associated with a lack of fiber in the diet. Symptoms include severe rectal pain during bowel movements, which can last from minutes to hours after. The pain is worse with constipation, which may occur if the patient has been avoiding bowel movements due to pain. Many patients report bright red blood on the toilet paper or the stool, though bleeding is usually not significant. If a fissure persists over time it may become a chronic fissure.

Your doctor will do a physical exam to confirm the diagnosis. Anal fissure require anoscopy as it cannot be directly observed visually. However, anoscopy is quite painful for those with an anal fissure so a doctor may treat it based on symptoms alone. You may need a colonoscopy to make sure no underlying disorder caused your rectal bleeding.

sphincterotomyInitial treatment is generally conservative in nature, with the goal of relieving constipation and breaking the cycle of hard bowel movements. Patients may take stool-bulking agents like fiber supplements and stool softeners, as well as laxatives to encourage regular bowel movements. Mineral oil can serve this purpose as well, but it is not advisable to be used indefinitely. Sitz baths after bowel movements are effective in relieving symptoms and helping the wound healing. About 80% of fissures resolve themselves without the need for surgery.

Acute anal fissures are fairly common and usually heal without treatment or with nonsurgical treatments. They may go away within two weeks. But if the tear doesn’t heal within six to eight weeks, you may need Botox injection or surgery for chronic anal fissure.

Botox has also shown to be a promising treatment, its relaxation effect on sphincters lasts for three months that is long enough for anal fissure to heal. If the anal fissure does not resolve following treatments, then a partial anal sphincterotomy may be needed, where a cut will be made on the anal sphincter in a different location in the anus, and both the fissure and new cut will heal together.

Nonsurgical treatments

If these first-line treatments do not work, the patient may be directed to use 0.4% nitroglycerine (NTG) ointment or compounding medication Nifedipine gel in conjunction the treatments listed above, and both may help it heal and reduce the discomfort. However, NTG ointment is generally not preferred as it can cause adverse side effects like headache and dizziness. Alternatively, Nifedipine gel is a better option to treat anal fissure.

Botox injection into the internal anal sphincter has 90% effective rate by paralyzing the muscle for up to three months, but the insurance doesn’t cover for the Botox injection.


If you have a chronic anal fissure that won’t heal on its own, surgery will most likely be the next option. The surgery, called partial anal sphincterotomy, may involve cutting a segment of the anal sphincter muscle to reduce spasm and promote healing, and may also include removing the fissure and any scar tissue resulting from it. Although rare, cutting the anal sphincter may lead to loss of ability to control bowel movements.

To help stop irritation and recurrences, as well as promote healing, you should increase fiber intake, drink enough fluids, exercise regularly, take baths, and avoid straining during bowel movements.

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