ANAL FISSURE

Definition
 An anal fissure is an elongated ulcer in the long axis
of the lower anal canal.
Epidemiology
 1 : 350
 Man : woman = 1 : 1
 Most commonly in young and middle age adults
Etiology and Phatogenesis
 A hard, dry bowel movement can cause a tear in the
anal lining, resulting in a fissure.
 Other causes of a fissure include diarrhoea and
inflammation of the anorectal area.
 Anal fissures may be acute (recent onset) or chronic
(present for a long time or recurring frequently). An
acute fissure is usually due to altered bowel habit
(constipation) while a chronic fissure may be either due
to poor bowel habit, overly tight or spastic anal
sphincter muscles, scarring or an underlying medical
problem such as anal cancer.
Principle Of Diagnosis
 Clinical manifestation
 sharp pain in the anal area during bowel movements
 a visible tear in the skin around anus
 streaks of blood on stools or on tissue paper after wiping
 burning or itching in the anal area

 Supporting examination
 Rectal toucher
 Anoscope : into rectum to make it easier to see the tear.
Using an anoscope may also help to find other causes of
anal or rectal pain such as hemorrhoids.
Treatments
 The principles underlying the treatment of anal
fissure are :
 Toachieve complete relaxation of the internal sphincter
which will aid in healing
 Maintenance of local hygiene
 Reduce inflammation in and around the fissure

 Non-surgical treatment : Sitz baths, stool softener,

increased dietary fibers, topical anaesthetic jellies,
antibiotics and analgesis constitute the conservative
line of the treatment for anal fissure.
 Surgical treatment
Reduction of anal canal presure can be achieved by
surgical methods fail. Anal stretching and lateral internal
sphincterotomy are the surgical modalities available for
treatment of anal fissure.
Complication
• Chronic anal fissure – the tear fails to heal. Over time,
this can cause extensive scar tissue at the site of the
fissure (sentinel pile).
• Anal fistulas – abnormal ‘tunnels’ join the anal canal to
surrounding organs, usually other parts of the bowel.
• Anal stenosis – the anal canal becomes abnormally
narrowed either due to spasm of the anal sphincter or
contraction of the resultant scar tissue.
Prognosis
More than 90% of patients who require surgery for
this problem have no further trouble from fissures.