Anal Fissures, Fistulas and Lesions
An anal fissure is a narrow tear that extends from the muscles that control the anus (sphincters) up into the anal canal. These tears usually develop when anal tissue is damaged during a hard bowel movement or when higher-than-normal tension develops in the anal sphincters.
Most people have experienced a tear or fissure at the corner of the mouth that can occur in cold weather or when yawning. Similarly, an anal fissure is a small tear in the lining of the anus, frequently caused by constipation. A hard, dry bowel movement results in a break in the tissue. However, fissures can also occur with severe bouts of diarrhea or inflammation. This results in the anus becoming dry and irritated, causing it to tear. Injury to the anal area during childbirth may be another cause.
A fissure can be quite painful during and immediately following bowel movements. This is because the anus and anal canal are ringed with muscles and nerves to control the passage of stool and to keep the anus tightly closed at other times. When those muscles expand, it stretches the fissure open. There may also be bleeding or itching with an anal fissure.
An anal fistula is a tube-like passage (tract) from the anal canal to a hole in the skin near the anus. This may occur after rectal surgery, after an abscess in the rectal area, or as a complication of a bowel disease.
Treatment for Fissures
More than half of all fissures heal either by themselves or with non-surgical treatment. Stool softeners can help reduce pain during bowel movements. Antibiotics may be used for a short time. Special medicated creams may also be used, to help promote healing and control the symptoms. A popular remedy is nitroglycerin ointment applied to the anal canal. This is the same medication used for coronary angina, but it is important to have the nitroglycerin diluted. Nitroglycerin works by improving blood flow.
It is important to keep the anus and area between the buttocks clean and dry. After bathing, the patient should gently pat dry with a soft towel. Applying talcum powder may help. Sitz baths may help relieve discomfort and promote healing. A sitz bath is soaking the anal area in plain warm — not hot — water for 15-20 minutes several times a day.
If the fissure is not responding to treatment, the physician re-examines the patient. There are conditions, such as muscle spasm or scarring, that could interfere with the healing process. Fissures that do not heal can be corrected with surgery. It is a minor operation that is usually done on an outpatient basis. The surgeon removes the fissure and any underlying scar tissue. Cutting a small portion of the anal muscle prevents spasm and improves blood flow. This helps the area to heal and rarely interferes with the control of bowel movements. Complete healing takes place in a few weeks. However, the pain often disappears after a few days.
Over 90% of the patients who need surgery for fissures have no further problems. Patients can help avoid the return of fissures by maintaining adequate fiber in the diet. This prevents constipation, which is the cause of most fissures.
Treatment for Anal Fistula
Treatment of anal fistula often varies, depending on whether Crohn’s disease is present. Crohn’s disease is a chronic inflammation of the bowel, including the small and large intestine. As noted, the physician will often do tests to see if this disease is present. If it is, then prolonged treatment with a variety of medications, including antibiotics, is usually undertaken. Often these medications will cure the infection and heal the fistula.
If Crohn’s disease is not present, it still may be worthwhile to try a course of antibiotics. If these do not work, surgery is usually very effective. The surgeon opens the fistula channel so that healing occurs from the inside out. Sometimes drains, called setons or mushroom-shaped catheters, are placed. Most of the time, fistula surgery is done on an outpatient basis or with a short hospital stay. Following surgery, there may be mild to moderate discomfort for a few days, but patients usually have a short recovery period.