An anal fissure is a small tear on the skin around the anal canal that often give symptoms of bright red bleeding and pain on passing a bowel motion. This can either be an acute anal fissure or a chronic, long-standing, non-healing anal fissure.
If you have these symptoms, we will carefully assess you with a history and clinical examination. We will inspect the back passage area, although it is sometimes too painful to do an internal rectal examination in the clinic.
We offer treatment for anal fissure, which includes simple medical treatment with lotions that aim to relax the sphincter muscle and promote healing of the fissure, which include either GTN ointment or diltiazem cream. We often combine these with stool softener to ensure the bowel motion is soft to prevent stretching around the fissure again. We will also provide dietary advice.
For patients who fail medical treatment, we can examine under anaesthetic to thoroughly assess the anal canal and look carefully at the fissure itself. We can combine this with an injection of Botox into the sphincter, aiming to give a longer-term relaxation of the anal sphincter to all the fissure to heal. We can repeat this procedure should the symptoms recur.
As a last resort for anal fissures, some patients require a permanent cut to the sphincter, called a lateral sphincterotomy. This can have good results of fissure healing but carries a risk of permanent incontinence, especially to flatus. If this treatment is required, we may need to formally assess your anal sphincters before considering the operation.