Surgery If your fissure does not heal in four weeks or you have had your fissure for a long time you may need surgery. The surgeon will cut the fissure open in a procedure called a sphincterotomy. This will hurt initially but the fissure will be gone and probably won't come back.
If someone has a chronic fissure, it is thought that the reason it has not healed is that the ring muscle (sphincter) that goes around the anus (back passage) has become so tense that the flow of blood to the lining of the anus is reduced.
Anal fissures usually heal within a few weeks without the need for treatment. But they can easily come back if they're caused by constipation that remains untreated. In some people, symptoms from anal fissures last 6 weeks or more (chronic anal fissures).
Take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soak in warm water for 10 to 20 minutes several times a day, especially after bowel movements. This can help relax the sphincter and promote healing. If symptoms persist, you'll likely need further treatment.
Chronic fissures typically have a cyclical history of intermittent healing and recurrence, but about 35% will eventually heal, at least temporarily, without intervention.
Some people get fissures once in awhile and others can become chronic, lasting for years. The pain of a fissure may cause people to avoid having a bowel movement leading to chronic constipation.
Living with anal fissures
Get the recommended amount of fiber in your diet. Avoid constipation or large or hard bowel movements. Drink enough water to stay well hydrated. Maintain a routine bowel habit.
Anal Fissures and Colon Cancer
People with colon cancer may develop anal fissures, but anal fissures don't cause colon cancer or increase your risk of getting colon cancer. Even if your anal fissure heals completely, it can come back after you have a hard bowel movement. This doesn't mean you have colon cancer.
The pain and discomfort of an anal fissure usually gets worse when a person has a bowel movement. The pain tends to linger a long time afterward. There may be bleeding from the tear as well. Constipation may also occur as the condition gets worse.
Post-treatment VAS for acute fissure was significantly lower at 6 weeks. Patients with acute fissure achieved significantly better healing than chronic fissure. Healing declined from 100% when symptoms were < one month to 33.3% when symptoms >6 months.
See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.
SURGICAL TREATMENT
Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal.
“Fissure treatment without surgery can be successfully achieved in 90% cases,” says Dr Amarchand Bajaj, Senior Consultant Surgeon at Sitaram Bhartia in Delhi. Fissure in ano is a common condition seen in adults between 20-40 years of age. It is frequently confused with piles because they both have similar symptoms.
It usually isn't a serious condition, and most people can treat it at home. However, recurring anal fissures or ones that don't readily heal can be cause for concern.
Acute fissures can become chronic, and sentinel pile can result. A permanent skin tag can result, and fistulas may form.
An acute fissure appears as a superficial laceration with well demarcated edges (like a paper cut). Chronic fissures are wider and deeper than acute fissures, and have raised edges that may be swollen. Sphincter muscle fibres may be visible at the base of a chronic fissure.
On the face of it, it may seem like not much, however, if you have a hole in your gastrointestinal (GI) tract, you could develop an infection and that could lead to sepsis.
Further evaluation may be required if there is concern that another medical condition may have contributed to the development of the fissure. If the diagnosis is unclear, a sigmoidoscopy or colonoscopy is usually recommended, especially if there has been rectal bleeding.
You should expect some pain and discomfort in your bottom (anus) after anal fissure surgery. The pain is usually worst during the first seven days after the operation and should get much better after this first week.
Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. This can make bowel movements easier after surgery. Use baby wipes or medicated pads, such as Tucks, instead of toilet paper after a bowel movement.
Most anal fissures heal with home treatment after a few days or weeks. These are called short-term (acute) anal fissures. If you have an anal fissure that hasn't healed after 8 to 12 weeks, it is considered a long-term (chronic) fissure. A chronic fissure may need medical treatment.
Nitroglycerin rectal ointment is used to relieve moderate to severe pain caused by chronic anal fissures. An anal fissure is a tear in the skin around the opening for bowel movements, also known as the anus or rectal area. Nitroglycerin belongs to the group of medicines called nitrates.