Anal fissure is a small crack or tear in the internal lining of the anal canal. It occurs as a result of hard stools causing trauma to the delicate lining while being passed outside. Other causes include repeated episodes of diarrhoea, infections of the anal canal and trauma to anal canal during childbirth. It is very painful condition since the lining of the anal canal is very sensitive and causes the muscles surrounding the anal canal to go into spasm. This further increases pain during defecation and makes the passage of stools even more difficult.
The most common symptom of this condition is pain. There may be associated burning and itching in perianal area. There is also bleeding which is found as a bright red streak on the side of the faeces. In long standing cases, there might be an extra bit of skin hanging outside which causes persistent itching and discharge. The diagnosis is confirmed during physical examination which shows puckering of skin around the anus suggestive of spasm. Digital examination is very painful for the patient and so it is better avoided and the fissure can often be visualised by spreading the buttocks apart.
The treatment for this condition depends upon the duration and severity of symptoms. If the fissure is of recent onset, a conservative treatment with diet modification, laxatives, numbing creams and pain killers are tried. This is mostly successful in relieving the symptoms and the fissure heals by itself within 3-4 weeks. In case the symptoms are long standing and severe, operative intervention may be required. The operation for fissure is lateral anal sphincterotomy in which a part of the internal sphincter is divided to relieve the spasm. This leads to amelioration of pain and also increases the blood supply to the affected area which helps in the healing of this ulcer. The surgery can be done as a day care procedure under regional anaesthesia and usually has good results with few complications.