Anal Fissure Treatment - Causes, Symptoms, Diagnosis, Recovery and more

What is an Anal fissure?

An anal fissure is a tear or cut in the thin lining of your anus that exposes the muscle around which is called the anal sphincter. The damage in the skin can often pull apart the edges of the fissure, causing the muscle to spasm, and making the condition worsen. Once the spasm occurs, the condition can be painful and the wound may take time to heal. Chronic diarrhea and constipation are bowel conditions that make anal fissures worse over time.

Irrespective of age and gender, any individual can be at risk of developing an anal fissure. Although medical reports suggest that people between the age group of 20 to 40 are more at risk of getting anal fissures.

Types, Causes and Symptoms of Anal Fissure

Types of anal fissure

1. Acute anal fissure
2. Chronic anal fissure

Causes – Anal Fissure

• Chronic constipation
• Long-term diarrhea
• Rough anal sex
• Insertion of foreign materials in the anus
• Straining too much while passing a bowel movement
• Passing too hard, large, and dry stool
• Injury in the anal area
• Underlying conditions such as Crohn’s disease, anal cancer, sexually transmitted diseases
• Disruption in the blood flow to the anorectal area

Symptoms – Anal Fissure

• Difficulty passing stool
• Pain during bowel movements
• Blood along with stool
• Cracks and tears that appear in the anal canal
• Itching and burning sensation in the anal region
• Painful urination
• Foul-smelling anal discharge

Diagnosis - Anal Fissure Treatment

Tests for anal fissure diagnosis

An anal fissure is a small tear or cut on the lining of the anus. An anal fissure can be easily identified through the naked eye by an anorectal specialist. But to confirm the condition, the doctor might recommend undergoing the following tests for diagnosis:

Flexible sigmoidoscopy – For this test, the doctor will insert a thin, flexible tube that has a tiny camera attached at one end inside your anus. This test is most recommended in people who are younger than 50 years of age and have no risks of any anorectal disease.

Colonoscopy – In this test, the anorectal doctor inserts a thin, flexible tube inside the rectum to inspect the colon. Colonoscopy is feasible for people over 50 years of age. This test is also done in people who are at risk of colon cancer, chronic diarrhea, and severe abdominal pain due to an anorectal problem.

Anoscopy – Anoscopy is a test where a tubular device is inserted into the anus. The device gives a detailed imaging view of the anus and rectum and helps the doctor identify and locate where exactly the problem is.

Diagnosis by the doctor

The symptoms of anal fissure can often be confusing with that of piles or hemorrhoids. There are high chance that you would feel uncomfortable and ashamed talking about your symptoms to your doctor, but it is important to do so. An experienced proctologist can diagnose anal fissures just by physical examination. But to rule out the problem the fissure doctor may need to do a rectal examination to diagnose the condition in detail. In this process, the doctor inserts a gloved finger inside your anus to feel the abnormal growth.

Generally, anal fissures can be diagnosed with just a visual examination. But depending upon the severity of your condition, the anorectal doctor might need you to undergo more tests before defining the best line of treatment. Often, anal fissures are associated with other health conditions such as Crohn’s Disease and other serious conditions. In that case, the proctologist might recommend a sigmoidoscopy, colonoscopy, or anoscopy for better evaluation. Additionally, the doctor might also ask you the following questions to understand your condition better:

• Since when did you start feeling pain in your anal region?
• How painful is your bowel movement?
• Does anyone in your family have anal fissures?
• What is your regular dietary routine like?
• Are you physically active?

Anal Fissure Treatment Options, cost and Insurance Coverage

Non-Surgical Anal Fissure Treatment

After anal fissure surgery

1. Use of topical ointments – If you are suffering from anal fissure, you can try applying topical ointments to your cut or tear. You can either use topical ointments recommended by the doctor or get them over the counter. You can get relief from the condition by using medicines such as lidocaine hydrochloride (XYlocaine).
2. Nitroglycerin – You can externally apply nitroglycerin to your anal fissure to increase blood flow to the damaged tissues. This in turn can help you promote healing and provide relief to your anal sphincter muscles. When home remedies and medicines fail to provide relief, most people resort to using nitroglycerin as a feasible line of treatment.
3. Medications for blood pressure – Oral medications such as nifedipine or diltiazem can enhance blood pressure and provide relief to the anal sphincter muscle. These medications can be used either orally or can be applied externally. Blood pressure medicines can be taken when medicines like nitroglycerin fail or are not effective.
4. Botox injections – Another non-surgical option for treating anal fissures is injecting botox. Botox injection paralyzes the anal sphincter muscles and provides relief to the spasms.

Surgical Anal Fissure Treatment

If your anal fissure does not go away with medicinal treatments or any other treatment methods, it could be an indication of chronic anal fissure. In that case, the proctologist may recommend you undergo surgery for permanent treatment for anal fissure.

Open surgery – In open surgery, the anorectal surgeon makes a small incision in the anal sphincter to relax the anal muscle. Once the muscle is relaxed, it lets the anal fissure heal. Open anal fissure surgery is a conventional treatment procedure that comes with a certain amount of risks and complications, permanent incontinence being the most common one.

Laser surgery – During the procedure, the fissure doctor first administers local or general anesthesia to the patient. The doctor uses a laser probe to emit infrared radiation or laser beams at the surgical site [location of anal fissure]. The high-energy laser beams increase the blood flow to the area of the fissure and promote quick and proper healing of the fissure.

How to prepare for anal fissure surgery?

Before undergoing anal fissure surgery, it is important to make sure that you follow all the tips and advice from the doctor. Some of the tips for surgery preparation may include the following:

It is highly likely that the fissure doctor will tell you everything about the treatment procedure. All you need to do is follow the instructions diligently. If you are allergic to any medication, let the doctor know in advance.

• Quit drinking alcohol and smoking cigarettes at least a week before the surgery. This will help you recover and heal after the surgery quickly and in a much more efficient manner.
• From the night before the surgery date, try to avoid eating heavy or large meals.
• On the day of the surgery, leave your valuable items at home while coming to the hospital.
• Get someone along with you while coming to the hospital for surgery who can help you drive home as you will not be allowed to drive.
• Get answers to all your questions about the surgery from the attending doctor or the surgeon.
• Before undergoing surgery, make sure either you or your guardian signs the consent form.

What to expect after the anal fissure surgery?

Anal fissure surgery is most commonly done on an outpatient basis. Right after the surgery, the patient will be taken to a private recovery room. You will be kept under observation in the private ward and your vitals shall be monitored until you gain consciousness. Once the doctor sees it fit, you will be sent home after that.

Most patients with anal fissure – both open and laser – do not require more than 1-2 days of hospital stay. So, it is highly likely that you can leave for home within a day or two. Your surgeon or fissure specialist will give you pain relievers to be taken during the course of the treatment.

You may see drops of blood in your innerwear, toilet paper, and in your stool. You are also likely to feel some pain in your surgical site for a few days. There is nothing to fret about, it is normal. However, if you experience anything unusual in your health, it is extremely important to notify your doctor.

After anal fissure surgery

1. Avoid all sorts of strenuous activities for a week or two after the surgery. Do not lift any heavy weights that can put pressure and strain on your surgical area.
2. Take sitz baths at least 3-4 times a day or preferably after each bowel movement until the surgical site heals.
3. You may bleed or feel itching at the surgical site for at least a few days after the surgery. A little bleeding and itching are common and normal.
4. Try to prevent constipation. Prevent any measures that can cause constipation. Eat a fiber-rich diet, drink a lot of water, and do not hold your motion when you need to go.
5. If your doctor has given any prescription for medication, you should make sure that you apply for the medicine at least two-three times a day at the surgical site or anal opening.
6. Avoid using dry tissues to wipe yu anal opening after bowel movements for a few days. If at all you need to use, try using wet wipes instead.
7. Consume a lot of fruits and vegetables.
8. Cut down on the consumption of alcohol and caffeine. This may disturb your digestive system and may irritate your bowel functioning.
9. Make sure to follow up with your doctor after the surgery. Making sure that you are on the right path to recovery can make a lot of difference in your overall health in the long term.

Insurance Coverage – Anal Fissure Treatment

The treatment of anal fissure is generally covered under health insurance. Most insurance companies offer a specific amount of coverage for anal fissures and other anorectal diseases. The amount of coverage you have will depend on the policy you buy.

It is important to note that the medical treatment for anal fissure won’t be covered under an insurance policy. Only the expenses of surgical treatment are covered. You also need to be hospitalized for at least 24 hours to file an insurance claim. You can opt for cashless payment or get reimbursement claims from your insurance providers as well.

If your claim is approved, you will be able to cover the entire cost of treatment, including diagnostic tests, medications, hospital stay, bed charges, and other consumables. Some of the best and most popular healthcare insurance providers are Oriental, Religare Health, Manipal Cigna, United India Insurance, Care Health, New India Insurance, Star Health & Allied, Bajaj Allianz General Insurance, ICICIA Lombard, Max Bupa Health Insurance.

Recovery Timeline - Anal Fissure Treatment

The recovery rate after any surgery depends from individual to individual. The healing capacity of every person is different and hence the timeline of recovery after anal fissure surgery varies for all. In most cases, recovery after open surgery for an anal fissure takes around 2-3 months and complete recovery after laser surgery takes 1 month to 45 days.

Recovery after 1 month

After anal fissure surgery, for at least 1 month, the patient needs to follow the recovery tips and recommendations of the doctor. It is advisable that the patient refrain from doing anything that puts strain on the surgical site. The patient should not eat anything too oily and spicy and consume only fiber-rich food. The patient should keep the surgical area free of any infection and take regular sitz baths.

Recovery after 2 months

After 2 months, the patient would experience much relief from the pain at the surgery site. But there might be scars. The scars would take a few more days to heal and disappear completely. The patient might get back to normal work life without any major complications and also resume normal dietary habits.

Recovery after 3 months

After 3 months, the patient would be free from all post-surgery discomfort. There would be minimal scars at the surgical site and the wound would be healed completely too.

Prevention of Anal Fissure

The following tips and preventive measures can help prevent anal fissure:

1. Consume enough fiber – Anal fissures can get worse due to hard and dry stools. If you want to prevent anal fissure, you need to take all possible measures to prevent constipation and the easiest way to do that is by adding enough fiber to your diet in the form of vegetables and fruits. Good sources of fiber include:
   • Oat bran
   • Beans, nuts and peas
   • Wheat bran
   • Whole grains
   • Oatmeal, pulses, cereals
   • Prunes and citrus fruits
2. Stay hydrated – Staying hydrated is a good way to prevent constipation. If you wish to make your stool softer, you need to make sure that you drink a lot of water along with the consumption of fiber-rich foods. Be sure that you add only healthy drinks to your daily regime, and not caffeinated and alcoholic drinks. Too much caffeine and alcohol can make you dehydrated and make your condition worse.
3. Don’t hold on to your urge to pass stool – Don’t fool your body; if you feel like going to the toilet, go. Don’t hold it till later. Holding for too long can strain your anal muscles and even disturb the signals that can let you know when to go to the toilet. Also, holding your bowel for too long can make your stool hard and dry.
4. Don’t take laxatives without the approval of your doctor – If medicines and other treatments do not provide you relief, you may resort to taking laxatives. Sometimes, laxatives may help in smooth bowel movements but most often laxatives can also contradict your health. As such, it is absolutely important that you take laxatives only after proper consultation from the doctor.

Risks & Complications of Anal Fissure

Risks/complications/contradictions during anal fissure treatment

In the majority of cases, anal fissure treatment is successful and the patient is satisfied. However, like any other surgery, there could be potential complications during the surgical process. Some of the complications and contradictions that can occur can include:

Hemorrhage – Although very rare to occur, there is a possibility of hemorrhage or bleeding occurring during the surgery of an anal fissure. If an unexpected hemorrhage occurs, the doctor may need to perform additional surgery to stop the bleeding.

Incontinence – Several patients report suffering from temporary incontinence immediately after the surgery. During this phase, the patient can experience leakage of stool and can face difficulty in holding gas. The problem is not likely to remain for more than 2-3 weeks and can remain until the patient recovers completely. Once the person heals completely, the problem of incontinence is highly likely to go away.

Perianal abscess – Though the complication is not very common, there are people who have suffered from an abscess and also developed an anal fistula after the surgery of an anal fissure. In such cases, the patient may require another surgery to get the abscess drained.

Tear extending to the surrounding muscle – Damage to the anal sphincter or surrounding muscle or nerves can be due to direct thermal or mechanical trauma and even due to some infection developed later. This can also result in incontinence. A meticulous surgery procedure is very important to avoid this issue by keeping the integrity of anal sphincters in check.

Risks factors of anal fissure

The following factors can put you at risk of getting anal fissure:

• Intense diarrhea
• Chronic constipation
• Straining while passing stool
• Eating low-fiber diet
• Any weight-loss surgery in the recent time
• Trauma caused to the anal area due to any injury or accident
• Any inflammatory problem in the anal area.