Anal fissure is a superficial tear (ulceration) in the lining of the anal canal. Its cause is most often unknown, but it is suspected that overactivity of the internal anal sphincter might lead to a decrease in tissue vascularity and ulceration. Anal fissure can also form as a result of trauma (for example vaginal childbirth, anal intercourse, constipation with painful passage of stool, long-lasting diarrhea), infections or chronic inflammatory diseases, or even be linked to cancer.
Anal fissure leads to severe pain when defecating
The most common manifestation of anal fissure is severe pain in the perianal area, especially during defecation. Its diagnosis requires a clinical examination with anoscopy .
The medical treatment of anal fissure is based on the use of laxatives and local anesthetics, such as creams. Treatment to relax the internal anal sphincter is usually added, such as nitric oxide (NO) creams, calcium channel blockers or injection of botulinum toxin .
Surgical treatment for chronic anal fissures
Surgical treatment is reserved for chronic or recurrent fissures. It consists in a fissurectomy, which removes a strip of skin at the site of the fissure, which is replaced by a part of the rectal wall. It can be combined or not with other treatments, such as the division of the sphincter (lateral sphincterectomy), allowing to decrease the tension on the tissue. In case of recurrence, additional examinations are sometimes necessary and treatment including reconstruction of the area may be required.