An anal fissure is a common disease that affects people of all ages.
An anal fissure is a tear of the anal skin that cause itching, discomfort, bleeding, and dull pain during and after defecation.
It can be acute or “short-term”, which heals by itself in a few days, and chronic or “long-term” with no healing in 12 weeks.
Anal fissures can be caused by:
In fact, the extra tension in the two muscular rings (sphincters) controlling the anus may cause fissures as well. The outer anal sphincter is under your conscious control but the inner sphincter is not. This muscle is under pressure or tension, all of the time for keeping the anal canal closed. If the pressure increases too much, it can cause spasms and reduce blood flow to the anus, leading to a fissure. This pressure can also prevent the fissure from healing.
Initially, medical therapy with special local ointment, stool softener, and painkillers is attempted.
If the fissure is not healing in 3 months and scar tissue is forming, then surgery is the only way to guarantee healing for the patient.
Normally, surgical Fissurectomy is the only necessary treatment. Contextual sentinel polyp asportation is mandatory.
In more advanced cases, anal flap fashioning is necessary in order to make the fissure heal correctly.
In the few cases where the muscle spasm is the main causative component, a little incision on the inner sphincter might be necessary which is called Lateral Sphincterotomy, always taking utmost care to safeguard the continence.
In Some Cases, Botox Injections for Anal fissures are a successful treatment for pain caused by muscular spasms in various areas of the body including the anal sphincter.
All the procedures are performed with minimally invasive techniques, allowing the patient to be operated on in a Day Surgery setting, with minimal pain and a quick return to daily activities.
The main etiology of chronic anal fissures is the internal sphincter spasm. Therefore, the goal of treatment for this medical situation is to lessen internal sphincter hypertonia by making a tinny incision in internal sphincter fibers.
Sphincter hypertonia is diagnosed by Anorectal manometry which is used to measure the pressure, reflex, and sensation of the anal and rectum muscles. lateral internal sphincterotomy is the most popular surgical method for treating chronic anal fissures, with excellent healing outcomes
It reduces sphincter hypertonia, which is the primary etiological factor in the onset of chronic anal fissures.