Anal fissures are small tears or cracks in the lining of the anus that cause pain, bleeding and/or itching, especially after a bowel movement. Occurring in men and women of all ages, fissures result from the stretching of anal mucosa beyond its normal capacity. Once a cut or tear occurs, it leads to repeated injury. Fissures that are new are referred to as acute. If they do not heal, they may become a constant or chronic problem.
Board certified colon and rectal surgeons at Brigham and Women’s Hospital (BWH) offer the most advanced and effective treatment for patients with anal fissures, including lifestyle recommendations, medication management and minimally invasive surgery such as sphincterotomy, a technique that releases pressure inside the anus and promotes healing of anal tissues.
Depending upon the severity of your anal fissure, your colorectal surgeon will recommend an individualized treatment plan which can help relax the anal sphincter and promote healing.
Medications such as nitrates or calcium blockers
Stool softeners such as fiber supplements
Steroid creams to relieve discomfort
Botox injections to relax spasms
Changing your diet to increase fiber and water
Taking warm baths for up to 20 minutes a day
People whose anal fissures do not heal well may have an imbalance in anal pressure that prevents blood from circulating normally through the blood vessels around the anus. If symptoms persist, surgical treatment may be necessary:
Lateral internal sphincterotomy A small portion of the distal internal sphincter is cut and divided to relieve chronic spasm. The procedure is successful in curing chronic anal fissures. Changes in continence can occur, so it is reserved for patients who have failed non-surgical treatments.
Fissurectomy Excision of the fissure
Anal advancement flap Covering the fissure with tissue from another part of the body
Anal dilation Rare procedure that widens and stretches the anal canal
You will receive a thorough diagnostic examination to evaluate if you have anal fissures and if surgery is needed. Careful monitoring and the involvement of an experienced colon and rectal surgeon are important to the successful outcome for patients with colorectal conditions.
The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in anal fissure surgery. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.
Brigham and Women's Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues who have extensive experience in diagnosing and treating anal fissures. In addition, patients have full access to BWH's world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.