Anal Fissure

• Sharp, burning or tearing pain when passing a stool
• Pain that can continue for minutes to hours after going to the toilet
• Bright red blood on the toilet paper or the surface of the stool
• A visible small tear or split in the skin at the anal opening
• A small skin tag near the fissure in longer-standing cases
• Spasm or tightness of the back passage
• Avoiding or fearing bowel movements because of the pain

Anal fissures most often occur when a hard or large stool stretches and tears the delicate lining of the anal canal, which is why constipation and straining are the leading causes. Persistent diarrhoea can also irritate and split the lining. Once a tear forms, the surrounding muscle (the internal anal sphincter) frequently goes into spasm, which both causes pain and reduces blood flow to the area, making healing difficult and allowing the fissure to become chronic.

Other contributing factors include childbirth, reduced blood supply to the area and previous anal surgery. Fissures that appear in unusual positions, are multiple, or fail to heal despite treatment can occasionally be linked to underlying conditions such as inflammatory bowel disease or infection, and Mr Hussain will consider these where relevant.

Mr Hussain usually diagnoses an anal fissure from the typical history of sharp pain and bleeding on passing a stool, together with a gentle examination. The fissure can often be seen by carefully inspecting the anal opening, and a skin tag may point to a long-standing problem. Because the area is frequently very tender, examination is carried out as gently as possible and an internal examination is sometimes deferred until the pain settles.

If the diagnosis is uncertain, the fissure is in an atypical position, or it fails to heal, Mr Hussain may recommend an examination under anaesthetic so the area can be assessed thoroughly without discomfort, and he may arrange further investigations such as proctoscopy or colonoscopy to exclude other conditions. This careful approach ensures the right treatment is chosen and more serious problems are not overlooked.

Because a fissure can be very tender, Mr Hussain examines the area as gently as possible at your consultation, and will sometimes defer an internal examination until the pain has eased. He explains the stepped approach — starting with stool-softening measures and creams — and only moves on to a procedure if these do not work, so most people avoid surgery altogether.

If a Botox injection, examination under anaesthetic or sphincterotomy is needed, it is a short day-case procedure under anaesthetic, usually taking around fifteen minutes. You are admitted on the morning of your procedure and go home the same day. Mr Hussain provides painkillers, laxatives to keep stools soft and advice on warm baths, and arranges a review to confirm the fissure has healed.

With creams or conservative treatment, many fissures heal over several weeks, and it is important to continue the measures that keep the stool soft even once the pain has eased, to prevent the fissure returning. After a Botox injection, the muscle gradually relaxes over the following days and any temporary effect on bowel control settles as the toxin wears off.

After a lateral internal sphincterotomy, most people go home the same day and notice an improvement in pain quite quickly, with the wound healing over a few weeks. Mr Hussain advises a high-fibre diet, good fluid intake and warm baths to support recovery, and most patients return to work within a few days to a week. He reviews patients afterwards to confirm the fissure has healed.