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An anal fissure is a simple tear in the anal canal. Due to a similarity in symptoms it is commonly misdiagnosed as hemorrhoidal thrombosis or hemorrhoidal prolapse.
Typically, there is pain and bleeding during or after defecation.
Constipation that results in passing a hard, bulky and dry bowel movement is most frequently associated with an anal fissure. Other conditions that can cause a fissure include inflammatory bowel disease and diarrhea. There is often a skin tag (lump or flap of skin or flesh) associated with an anal fissure.
The majority of the patients will heal without surgery. A high fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids will promote soft bowel movements and facilitate the healing. Warm sitz baths for 15 minutes several times each day can also help healing. Nitroglycerin ointment or topical Calcium Channel Blockers and perhaps Botox may be recommended. If conservative treatment and management is unsuccessful then surgery may be required.
Fissures recur frequently due to hard stool and constipation. If the problem returns without an obvious cause then further investigation is needed. If surgery is necessary, the results are usually very effective resulting in subsequent low recurrence rates.
The patient needs to be re-examined to rule out the possibility of other problems, such as an inflammatory bowel disease or tumors, that can produce similar symptoms.
A lateral internal sphincterotomy (small surgery to cut a portion of the internal anal sphincter) is the procedure of choice. It is an outpatient procedure that can be performed either in a clinical office setting or an operating room.
Complete healing takes 3-4 weeks however pain is often relieved in a matter of days.