The cause of the anal fissure may arise after an anal injury. The passage of a hard constipated stool is its most common cause. Other causes of the condition occurs after having diarrhea, giving birth, inflammatory bowel disease (Crohn's)and, sometimes, certain medical procedures like the insertion of endoscope or ultrasound probe can cause trauma, resulting to fissure.
The fissure can either be chronic or acute. It heals within a period of six weeks, if it does not, it is called chronic anal fissure. An acute onset fissure quickly resolves.
The symptom of this condition is characterized by a sharp or burning pain in and around the anus which may be accompanied by blood during bowel movement. A sentinel pile can be seen on the edge of the anus below the fissure. This is a tag of skin and is not a hemorrhoid.
Diagnosis by a doctor is done by gently parting the buttocks to see if there is a fissure. If there is no visible fissure, a cotton swab may be gently inserted into the anus to detect the source of pain. Doctors may refer a patient to a colorectal surgeon if he thinks a situation calls for that.
Most anal fissure heals spontaneously without the need of surgery.
Some very practical methods that can be done are dietary management like incorporating fiber rich food in the diet, stool softeners and frequent warm baths. To reduce the pain during defecation, topical anesthetics like xylocaine, lidocaine, tetracain, and pramoxine are applied. To reduce inflammation a small amount of steroid may be combined with the anesthetic cream.
If surgery is indicated, a sphincterotomy is recommended. Done under anesthesia, the operation involves cutting the anal opening with the division of the lowest part of the sphincter muscle of the anus. It will relieve the spasm and will enable healing of the fissure. The rarest complication of a surgery would be the loss of control of bowel movement.
