Patient Information

Anal Fissure

An anal fissure is a small tear in the lining of the back passage. Although not dangerous, fissures can be extremely painful and significantly affect quality of life.

What is an Anal Fissure?

An anal fissure is a small tear in the lining of the back passage (anus). Fissures are very common and can affect people of all ages. They are most often caused by stretching of the anal canal during the passage of hard stools or constipation, and occasionally by diarrhoea, childbirth, or other irritation. Some fissures become chronic — failing to heal over time and sometimes associated with a small skin tag at the outer edge of the anus.

Common Symptoms

—Sharp or burning pain during and after opening the bowels

—Pain lasting from minutes to several hours after a bowel motion

—Bright red bleeding, usually seen on the toilet paper

—Spasm or tightness of the anal sphincter muscle

—Fear of opening the bowels due to pain

—Itching or irritation around the anus

Self-Help & Home Treatment

Many fissures improve by keeping stools soft and reducing irritation:

·Avoid constipation and straining — increase fluids and fibre

·A fibre supplement (e.g. Fybogel) or gentle laxative may help

·Warm baths or showers after opening the bowels

·Simple pain relief such as paracetamol or ibuprofen

·Gentle cleaning — avoid perfumed soaps or wipes

Medical Treatment

GTN Ointment

Relaxes the anal sphincter muscle, reducing spasm and improving blood supply. Applied two to three times daily for 6–8 weeks. Heals fissures in approximately 50–70% of patients. The most common side effect is headache.

Diltiazem Cream

An alternative to GTN with similar healing rates (60–70%) and fewer headaches. Applied twice daily for 6–8 weeks. Both treatments work best alongside measures to keep stools soft.

Surgical Options

Botox Injection & Fissurectomy

Botulinum toxin (Botox) is injected into the sphincter muscle to temporarily relax the spasm that prevents healing. Often combined with fissurectomy (tidying the fissure edges) to encourage healing. Day case under general anaesthetic. Effective while avoiding permanent muscle division.

Lateral Internal Sphincterotomy

A small portion of the internal anal sphincter muscle is partially divided to reduce spasm. Very effective, but reserved for carefully selected patients as it involves permanent muscle division.

When to Seek Medical Advice

—Persistent anal pain or bleeding

—Symptoms lasting more than a few weeks

—Difficulty opening your bowels due to pain

—A lump, swelling or discharge

—Change in bowel habit or unexplained weight loss

—Symptoms that do not improve with simple treatment

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