Chronic anal fissure

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Chronic fissures are generally more difficult to treat, and your surgeon may advise surgical treatment either as an initial treatment or following attempts at medical management. Both of these are performed typically as outpatient procedures. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. You'll usually have to use GTN ointment for at least 6 weeks, or until your fissure has completely healed. Some patients may benefit from an alternative surgery called an anal advancement flap anoplasty.

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Patients note severe pain during, and especially after a bowel movement, lasting from several minutes to a few hours. Misdiagnosis of an anal fissure may also allow other conditions to go undetected and untreated, such as serious infections or even cancer. Fissures are usually caused by trauma to the inner lining of the anus. Oral forms of calcium channel blockers are also available, but these generally result in less fissure healing and more side effects than topical treatment.

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The majority of acute fissures present for less than 6 weeks will heal with GTN treatment. Check here for alerts. These non-operative measures will help achieve resolution of pain and bleeding and, potentially, heal greater than half of acute fissures with virtually no side effects. This should prevent the muscle from spasming, helping reduce pain and allowing the fissure to heal. The goal of these surgical options is to promote relaxation of the anal sphincter, thereby decreasing anal pain and spasm, allowing the fissure to heal. Special consideration is given to patients with established anal incontinence, known anal sphincter muscle injury such as after obstetric injury or diarrheal conditions i. Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain.

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