Understanding Anal Fissures

What is an Anal Fissure?

An anal fissure is a small tear in the skin just inside the anus. Even though the tear is small, it can cause a lot of pain.
For many people, the discomfort settles after a few days or a few weeks, as the “acute” fissure heals on its own. However, in some cases, the fissure doesn’t heal and if it lasts longer than six weeks it becomes known as a chronic anal fissure and is unlikely to heal without treatment.

Common Symptoms

Anal fissures usually cause discomfort both during and after passing a bowel movement. During a bowel action people often describe a short-lived sensation that feels like “passing glass,” due to the stool passing over the fissure. After a bowel action, they are left with a dull ache due to spasm in the anal sphincter muscle, which is often even more uncomfortable and classically lasts about 30 to 60 minutes but others may experience more severe pain that can last for hours.

Treatment Options

Many people with fissures try laxatives (either on their own or after advice from their GP) to make going to the toilet easier and reduce the pain. That may be enough to manage acute fissures that rapidly heal, but if the fissure becomes chronic, then more active treatments are required.
The good news is that there are several effective treatments available to reduce pain and help the fissure heal. Treatments range from creams to minor surgical procedures. Your GP may have already started you on some of these.

Here are the main treatment options:

Prescribed creams or ointments
These are special creams that can only be given on prescription - not the ones you buy over the counter to treat piles/haemorrhoids (although they may help ease discomfort, they do not help to heal fissures). 
There are two main types: GTN or diltiazem cream and you apply a small amount directly to the area twice a day for four to six weeks. The cream helps relax the muscle, reduce pain, improve blood flow, and therefore encourage healing. Around 4 in 10 people find this is enough to fix the problem.
Note: GTN ointment can cause headaches in some people. If this happens you can take paracetamol and expect them to wear off with continued use. If not, speak with your doctor who may be able to offer you the alternative Diltiazem cream, or refer you for a surgical opinion.

Botox Injections

While most people associate Botox with cosmetic treatments, it’s also very useful for anal fissures.
Botox is injected into the sphincter muscle around the anus. Like the cream, it relaxes the muscle and improves blood supply, which helps with the pain and encourages healing. Success rates are good, with 60–80% of people healing after this treatment.
In the UK, we usually perform the Botox injection under a general anaesthetic, which means you're asleep during the procedure. This also gives us a chance to gently roughen the fissure wound to help ‘kick-start’ the healing process.

Surgery (Lateral Sphincterotomy)

This is usually only offered if other treatments haven’t worked. It is also a simple day-case procedure performed under general anaesthetic.
The surgeon carefully cuts a small portion of the anal muscle (sphincter) to reduce spasm, working even better than Botox, to ease pain, improve blood flow and therefore encouraging the fissure to heal. This surgery is very effective, with around 95% success.
There is a small risk (about 1 in 20 people) of experiencing poorer anal control of wind or minor seepage of liquid stool, which if it occurs may be permanent, therefore we usually try the other options first. However, for those with very severe or long-lasting pain, that has failed other treatments, this surgery can offer dramatic relief - sometimes within days.

When to seek help?

If you’ve had bleeding with pain when going to the toilet, it’s normal to feel worried. Your GP can often help and may be able to start you on the right treatments.
If your symptoms continue or you're unsure about what’s going on, I’d be happy to help. As a consultant surgeon with years of experience, I’ve supported many people through this issue - and helped them return to a pain-free life.

If you’d like to discuss your symptoms, get answers to your questions, or start treatment, booking a consultation is simple.

Please contact my private secretary, who will be happy to arrange an appointment at a time that works best for you.