Anorectal Conditions
Anal Fissure Treatment and Surgery in Ahmedabad
The anus is the last part of the intestine. It is a short, muscular, ring-like structure that opens during the passage of stool. An anal fissure is a crack or tear in the inner lining (mucosa) of the anus. GastroPlus Digestive Disease Centre assesses and treats anal fissures at its four hospitals in Ahmedabad — Vastrapur, Nikol, Bapunagar and Bopal.
Symptoms of an anal fissure
- Anal pain while passing stool, which may persist for some time even after the bowel movement
- Bright red blood on the toilet paper or in the toilet
- A feeling of itching or irritation around the anus
- A visible or palpable crack in the anal skin
- Constipation
Home measures that can help
An acute or new-onset fissure usually heals with medical therapy alone. Alongside any treatment your doctor advises, the following measures may help.
- Adding dietary fibre to food, with a daily intake of around 25-30 g
- Avoiding foods that are difficult to digest, such as nuts and popcorn
- Increasing the intake of liquids and fruit juice
- Sitz bath: sitting in warm water for at least 10-15 minutes so that the anus is soaked in it. This should be done at least three to four times daily, especially after passing stool. It relaxes spasm, increases blood flow to the local part, and cleans the area without causing discomfort.
Medical management
The goal of management is to break the vicious cycle of spasm of the anal sphincter and repeated tearing of the skin. The drugs that help are:
- Laxative: a laxative and stool softener help by avoiding straining, which in turn aids healing.
- Local anaesthetic, with or without steroid: a topical anaesthetic agent applied before a bowel movement helps reduce the pain associated with defecation. A small amount of steroid is sometimes combined with it to reduce local swelling.
- Local NTG cream: nitroglycerine helps relieve spasm and increases blood flow to the local part, which aids healing of the ulcer. It is usually prescribed at bedtime daily.
- CCB: a calcium channel blocker acts like NTG and is preferred, as it has a more favourable side-effect profile.
- Botulinum toxin: a newer technique that relieves spasm of the anal sphincter by injecting botulinum toxin into the anal canal. It is very costly and may have long-term side effects.
Surgical management
A chronic fissure may require surgical intervention. In case of resistance or intolerance to medical management, surgery may be needed. In this, the internal sphincter is cut, or stretched by finger, to relax the anal canal.
Frequently asked
What causes an anal fissure?
An anal fissure is caused by any damage to the inner lining of the anus. It usually occurs whenever there is undue stress, such as hard stool, chronic straining while passing stool, or sometimes explosive diarrhoea. Occasionally it may occur due to the insertion of a thermometer, enema, endoscope or ultrasound probe. It can also occur during childbirth, or it may be a symptom of a medical condition such as Crohn's disease, tuberculosis or another infection.
What are the symptoms of an anal fissure?
Anal pain while passing stool, which may persist for some time after the bowel movement; bright red blood on the toilet paper or in the toilet; itching or irritation around the anus; a visible or palpable crack in the anal skin; and constipation.
How is an anal fissure diagnosed?
A careful medical history usually points towards the diagnosis of an anal fissure, and gentle inspection of the anus can confirm it. Sometimes examination under anaesthesia may be required to diagnose and treat the condition. In case of rectal bleeding, the presence of warning symptoms, or suspicion of an underlying medical condition, colonoscopy or sigmoidoscopy is indicated.
How is an anal fissure treated?
An acute or new-onset fissure usually heals by medical therapy alone, while a chronic fissure may require surgical intervention.
Where to go next
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Book a consultation with a GastroPlus specialist — same-day appointments available.