Anal Fissure

An anal fissure looks and feels like a crack in the skin around your anus. You may also spot a small lump near the fissure.

If you have an anal fissure, you’re likely to experience pain in your bottom during bowel movements. The pain is usually quite intense and is commonly described as “like passing shards of glass”. The pain may also persist for several hours after a bowel movement.

There may also be bright red blood in your stool or on the toilet paper.

Anal fissures can be caused by constipation and the passage of hard stool. However, they may also be caused by diarrhoea and the passage of frequent stool.

Rarer causes include:

• inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis

• pregnancy and childbirth

• sexually transmitted infections (STIs), such as syphilis or herpes, which can infect the lining of your anal canal

However, in some cases, no clear cause can be identified.

Risk factors

You may be more at risk of developing an anal fissure if:

• you are or have been constipated

• you have given birth

• you have penetrative anal sex

Your consultant will see you for an initial consultation. They’ll ask you about your medical history and symptoms and examine your bottom. Sometimes this may require an internal examination, although this may not be attempted if you’re in pain.

In some cases, you may need to have further tests, which could include:

• anoscopy (to examine your rectum and anus)

• colonoscopy (to examine your colon)

• sigmoidoscopy (to examine the lower part of your colon)

It’s important for your consultant to rule out other causes of pain so they can make an accurate diagnosis and therefore recommend the most appropriate treatment for you.

You may be able to prevent an anal fissure from coming back, or help one to heal by following these lifestyle steps:

• don’t strain during bowel movements

• get 25 to 35 grams of fibre each day in your diet, through fruits, vegetables, and whole grains

• drink plenty of water

Most anal fissures get better with a little self-care and by following the recommended lifestyle measures and toilet habits.

Once you’ve had an anal fissure, you’re also more likely to experience further fissures. 

If you have a chronic anal fissure that isn’t treated, it may extend to your anal sphincter (the muscle around your anus). This can lead to more severe pain and may require surgery and medication to treat.

Your consultant will recommend the best treatment option for you, based on the severity of your anal fissure and what’s causing it. Your treatment options may include:

Changes to your lifestyle and/or toilet habits

If you’re constipated, you need to increase the amount of fibre in your diet. You should also exercise regularly and drink plenty of water.

It may also mean that you need some laxatives. It’s important that you avoid straining or spending more than a few minutes on the toilet.

You can also take simple pain relief such as paracetamol before you open your bowels, avoid using fragranced wet wipes, and regularly wash the area with plain water.

Medical treatment

Your consultant may recommend the application of an ointment. This is 0.2% GTN (glyceryl tri-nitrate). GTN ointment works by dilating the blood vessels in your anus, which promotes healing and relieves spasm within your anal canal. The ointment may give you a headache as a side effect. This can be relieved by taking paracetamol half an hour before using it. 

The second line treatment option is a cream, which may cause an itchy bottom. 

Typically, treatment will be needed for 6 to 8 weeks, and occasionally a second course of treatment is needed.

About 7 out of 10 people get better with these simple measures.

If you don’t recover, your consultant may recommend an injection of botulinum toxin (Botox). This is typically given under general anaesthesia. It works by paralysing 1 of the muscles in your bottom, which eases spasm and promotes blood flow to the injured area. 

The medicine lasts for 3 to 4 months and then wears off. It’s safe, with limited side effects. However, botulinum toxin will only work in about 50% of cases, and there’s a risk of temporary incontinence, infection, or the need for further treatment.

Surgery

If the above treatment measures don’t work, your consultant may recommend surgery known as a lateral sphincterotomy. The aim is to cut 1 of the muscles in your bottom to permanently reduce the spasm in your anal sphincter muscles. 

It works in about 90% of cases. It’s performed under general anaesthetic, and you’ll be able to go home that same day. Most people recover in about 2 to 4 weeks; however, 1 in 20 people experience some symptoms of incontinence. In most cases, this is temporary.

Very resistant or chronic fissures may require more complex treatment with surgery called advancement flaps. This procedure creates a flap of healthy tissue taken from the skin around your bottom, which is then stitched over the area of your fissure. This is a more complex procedure, which your consultant will discuss with you in more detail if necessary.

At Welbeck, our colorectal specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.