Anal Fissures

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The Function of the Anus

The anus plays a crucial role in bowel continence, enabling voluntary control over the expulsion of feces. This process is facilitated by peristalsis, muscular contractions that propel waste through the large intestine. After excess water is absorbed, waste material is stored in the rectum until it is expelled through the anus. The anus itself is equipped with a muscular ring, or sphincter, that opens to release feces. Its internal lining is known as the anal mucosa.

What Causes Anal Fissures?

Anal fissures, or tears in the lining of the anus or anal canal, are primarily caused by trauma to the inner tissue of the last part of the large intestine.

Primary Cause:

Constipation: The leading cause of anal fissures is constipation, where passing an unusually hard or large stool can tear the lining of the anal canal.

Additional Causes:

Persistent Diarrhea: Frequent, watery stools can also irritate and damage the anal lining.
Chronic Constipation: Regular difficulty in passing stool due to its dry and hard nature.
Rough or Excessive Wiping: Aggressive cleaning of the anus post-defecation can cause or exacerbate fissures.
Inflammatory Conditions: Inflammation of the anus and rectum, including conditions such as Crohn's disease, contributes to fissure development.
Infection: Reactions to infections, such as a pinworm infestation, leading to scratching and subsequent tearing of the anal lining.
Physical Stressors: Anal injury, pregnancy, childbirth, and even rectal cancer can cause the formation of anal fissures.

Understanding these causes is crucial for preventing anal fissures and seeking appropriate treatment when they occur.

Surgical Treatments for Anal Fissures

Surgical Interventions for Severe Anal Fissures:

For severe cases of anal fissures, surgical correction is often necessary. The procedure involves:

Removal of the Fissure: The fissure along with any associated scar tissue is excised.
Sphincterotomy: A lateral internal sphincterotomy may be performed, involving the removal of a small segment of the anal sphincter muscle to facilitate healing without affecting sphincter control.
Anesthesia: The operation can be conducted under local anesthesia, making it less invasive for the patient.
Success Rate: Approximately 90% of patients do not experience a recurrence of an anal fissure post-surgery.

Self-Help Recommendations for Anal Fissures

Following medical advice is crucial, but general self-help suggestions include:

Petroleum Jelly Application: To ease anal discomfort.
Ointment Use: Consult a pharmacist for ointments specifically designed to alleviate anal pain.
Sitz Baths: Regular sitz baths involving sitting in warm water for about 20 minutes can be soothing.
Gentle Cleaning: Opt for baby wipes over toilet paper and shower or bathe after every bowel movement.
Hydration: Drink six to eight glasses of water daily to help soften stools.

Complications

Infection – the open wound may become infected.
An abscess – an infection can lead to a collection of pus near the fissure.
Fissure recurrence – even after healing, fissures can reappear.
Increased pain and bleeding – without treatment, the condition can worsen, leading to more significant discomfort and bleeding.

Understanding and addressing these complications early can help prevent more severe outcomes and improve overall healing and comfort.

Important Note: The above information is not a substitute for a thorough discussion with your surgeon regarding the necessity of surgery.

If you have inquiries about the appropriateness of surgery for your situation, alternative options, billing, insurance coverage, or your surgeon's qualifications and expertise, please feel free to contact us.

Should you have any questions pertaining to the surgical procedure or post-operative care, it is advisable to engage in discussions with your surgeon either prior to or following the operation.