Anal fissure is a tear or a split in the lining of the back passage (anus) usually brought on by a bout of constipation or straining at stool.
The predominant symptom is fresh red rectal bleeding with intense sharp pain on opening bowels which can last for a few minutes as spasms of pain. ‘It feels like passing razor blades’ is a common comment from patients.
Treatment for Anal fissure:
Stool softeners (Lactulose or laxido)
Specific measures: (In sequence)
- Smooth muscle relaxant ointments to apply around the anus:
Rectogesic (GTN) 0.4% ointment for acute fissure. Diltiazem 2% ointment for chronic or long standing fissures or those not helped by Rectogesic.
- Examination Under Anaesthesia (EUA) and injection of Botox (can be repeated).
- As a last resort EUA and Lateral Anal Sphincterotomy (LAS) where smooth muscle around back passage is partially divided.