Anal Fissure

What is an anal fissure? 
An anal fissure is a tear in the skin lining the outer edge of the rectum. These are usually caused by passage of a large, hard stool. Most of the time these tears heal by themselves. However, if they do not heal within three to four weeks, they may not heal at all unless surgically treated. The symptoms of an anal fissure consist of pain and bleeding, particularly with bowel movements. There are some medications that can be soothing, and decrease pain, but these often provide only temporary relief.

Most surgeons recommend surgery if the symptoms have persisted for longer than three or four weeks. Although there is usually no danger from delaying treatment having the fissure treated is often a great relief.

What is the operation like? 
This kind of surgery is usually done as an outpatient with local anesthesia (novocaine), spinal anesthesia or general anesthesia (asleep). Whichever method we decide upon, a long acting local anesthetic is injected that will minimize discomfort during the first eight to twelve hours after the operation.

The procedure consists of trimming the edges of the tear, and sewing the tear closed. One of the anal "sphincter" muscles is then partially divided. These are the muscles that control opening and closing the anus. Allowing this muscle to relax by partially dividing it, plays a major role in allowing the fissure to heal. Several weeks later, this muscle will have healed back together.

What is recovery like ?
The amount of discomfort a patient will have is difficult to predict. Everyone seems to be different in this respect. Some patients feel that the post operative discomfort is not much worse than the pain they had from the fissure itself.

It is important to avoid constipation after the surgery. This will minimize the discomfort with bowel movements. Moist surgeons recommend a bulk laxative such as Metamucil, Fibercon or Citrucel for about 2 months after the hemorrhoidectomy.

Although there are no real restrictions on activity after the surgery, most patients take about five to seven days at home to recuperate.

Steven C. Immerman, M.D., FACS © 2000.