WHAT IS AN ANAL FISSURE?

An anal fissure, also referred to as Fissure – in – ano, is an ulcer in the lower portion of the anal canal. This ulcer normally develops after trauma to the anus, commonly due to passage of hard constipated faeces with force, or from perineal tears during child birth.

Anal fissures which are less than three months old are acute fissure and those which are older than three months are chronic fissures.

WHY DON’T ANAL FISSURES HEAL SPONTANEOUSLY?

A tear in the mucosa of the lower portion of the anus causes severe pain which is made worse when passing faeces. The anal sphincters involuntarily contract to protect the tear from further injury, but the negative effect of this is a reduction in the blood supply to the ulcer. The sustained spasm of the anal sphincters during passage of stools and in-between increases the anal sphnicer tone, reduces blood supply to the ulcer which becomes a chronic fissure.

WHAT CAUSES THE SEVERE PAIN IN ANAL FISSURE?

The spasm of the anal sphincters reduce blood supply to the ulcer thereby causing pain from the ischaemis and the ulcer.

HOW IS ANAL FISSURE EVALUATED?

The severe anal pain in anal fissure preclude digital rectal examination in the surgeon’s office.

The ulcer is examined under anaesthesia in the theatre during when a definitive surgical treatment can be offered.

 

HOW IS ANAL FISSURE TREATED?

Acute anal fissures are treated with medications with good healing rates. These medicines which are applied to the anus help reduce the spasm of the anal sphincter thereby improving the blood supply to the fissure which may heal.

Chronic anal fissures are best treated with surgery since the degree of anal spasm and hypertrophy of the lower portion of the internal anal sphincter are not corrected with topical medications.

 

                                                                                                                                  Prof Jonathan CB Dakubo