Causes, signs & management of anal fissure

Anal fissure is a tear in the overlying skin of the anal canal; this fissure could be superficial (limited to the skin) or extends deeply to the underlying sphincter muscle.

Anal fissure usually develops due to overstretch of the anal mucosa, which is very common in chronic constipation or childbirth trauma in women.

The classic clinical picture of anal fissure includes the following:

1. Anal pain; especially during defecation.

2. Bright red anal bleeding.

3. Peri-anal swelling.
4. Local itching.
5. Constipation.

Non-surgical management is recommended initially, it consists of the following:

• Medication: it includes topical calcium channel blocker ointment, local anesthetic ointment as well as local or systemic antibiotics. Also stool softeners (laxatives) are recommended for chronic constipation.

• Following a high-fiber diet and drinking plenty of water to eliminate constipation.

• Personal hygiene, especially in the peri-anal area.
• Hot baths for promoting blood circulation in peri-anal area, which is very helpful in healing of anal fissures.

If all above measures failed, surgical repair of the anal fissure is done under general or spinal anesthesia.