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2019-01-02 / Columnists

Staying Well with Doc Surrell

Anal Fissures

First, let us review the medical definition of an anal fissure. An anal fissure is a small, sore spot located about one half-inch inside the anal opening. The symptoms of an anal fissure are pain and/or bleeding during and after bowel movements. The pain can be severe. Anal fissures also can be called anal ulcers.

The most common cause of an anal fissure is the passage of a large, hard stool that tears the lining of the anal canal just inside the anal opening. Of course, this will most commonly occur when a person is constipated and may not have had a recent normal bowel movement. Severe, frequent diarrhea also can cause an anal fissure, but is much less common.

Let us now review the treatment for anal fissures. I recommend a high fiber diet with fiber supplements, such as Sugar-free Metamucil, and always advise my patients to be sure to take their fiber supplement every day to keep their stools soft and easy to pass.

If the anal fissure pain is severe, and it can be, I also may prescribe anesthetic anal creams or ointments. If there’s no improvement on the high fiber diet, or if the anal fissure has been present for a longer period of time, a minor outpatient surgical procedure for the anal fissure likely will be recommended.

Here is a brief summary of the surgical procedure done to treat an anal fissure. The human anal canal has two muscles, called the internal and external anal sphincter. These muscles are used to close the anal canal to prevent the leakage of stool and gas out of the rectum.

Sometimes the internal sphincter muscle does not relax properly during a bowel movement, and the anal canal doesn’t open properly. Therefore, the passage of stool may cause a small tear in the anal canal.

This tear, known as an anal fissure, is painful during and after bowel movements. Anal fissure surgery involves making a small, partial cut into this internal sphincter muscle to allow it to properly relax during a bowel movement.

After this relatively minor outpatient surgery, the vast majority of anal fissures will heal within a few weeks. This is generally a very highly successful surgery. Patients are nearly always very satisfied with the results, as they have no more pain during and after bowel movements.

Anal fissures do not lead to more serious problems like cancer; however, it’s very important that all rectal bleeding be evaluated by a qualified healthcare provider. Rectal bleeding may represent a more serious condition, such as colon or rectal polyps or cancer, and its source must always be accurately determined.

We also may recommend further studies to assess the rectal bleeding, even if a person has a known anal fissure. It’s extremely important to discuss any rectal bleeding symptoms with your healthcare provider.

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