An anal fissure is a small tear in the skin covering the anal area, causing pain, bleeding and itching. Because the anal skin contains dense nerve endings, a fissure is very painful.
Causes
Passage of hard stools, chronic diarrhoea, birth trauma, Crohn's disease or surgical procedures on the anal region may cause anal fissures.
Symptoms
Severe burning pain during and after defecation, bright red blood on toilet paper, anal itching and cramping.
Acute and Chronic Fissure
Fissures lasting less than 6 weeks are considered acute; those lasting longer are considered chronic. In chronic fissures, a sentinel pile and hypertrophic anal papilla may develop.
Treatment
Conservative: Increasing fibre and water intake, sitz baths, topical anaesthetics and nitrate/calcium channel blocker creams.
Office procedure: Botulinum toxin injection.
Surgery: Lateral internal sphincterotomy (LIS) is the gold standard in refractory cases.