Anal Fissures

Dr. Sulaiman Bin Yusof

MbChB (Sheffield) M.Med (Surg) FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士

What is an Anal Fissure?

An anal fissure is a small tear or cut in the lining of the anus. This tear typically results from trauma, such as passing hard stools or straining during bowel movements.

The delicate tissue in the anal canal can be easily damaged, leading to pain and discomfort, especially during and after bowel movements. While some fissures heal naturally, others may persist and require medical treatment.

Causes of Anal Fissures

Several factors can contribute to the development of anal fissures:

Hard Stools

Passing hard stools can stretch the anal canal beyond its normal capacity, causing a tear in the lining of the anus.

Chronic Constipation

Repeated straining during bowel movements, often due to constipation, puts increased pressure on the anal canal, which can lead to fissures.

Chronic Diarrhoea

Watery stools can irritate the anal lining, potentially leading to a tear, especially if bowel movements occur frequently and the tissue does not have adequate time to heal between episodes.

Childbirth

During childbirth, the intense pressure exerted on the pelvic region can cause tears in the anal area, particularly with excessive straining.

Chronic Inflammatory Conditions

Conditions such as Crohn’s disease cause chronic inflammation in the digestive tract, weakening the anal lining, making it more susceptible to tearing.

Symptoms of Anal Fissures

Anal fissures cause noticeable symptoms due to the tear in the sensitive anal tissue. Common symptoms include:

Pain During Bowel Movements: Pain is usually sharp and intense as stool passes over the fissure, aggravating the tear. This is because the tear exposes underlying nerves, causing significant discomfort.

Bright Red Blood: Fissures may cause minor bleeding, with blood appearing on toilet paper or stool due to damage to blood vessels.

Itching or Irritation: As the fissure heals or becomes irritated, the surrounding tissue may become inflamed, causing itching or discomfort in the anal area.

Diagnosis of Anal Fissures

Anal fissures are diagnosed using specific tests to confirm the presence and severity of the condition.

Patient History

A detailed discussion of symptoms, such as pain and bleeding during bowel movements, and medical history, including constipation, diarrhoea, or childbirth, helps determine potential causes and assess if the fissure is acute or chronic.

Physical Examination

The surgeon inspects the anal area for visible tears, swelling, or signs of inflammation. This step helps identify superficial fissures quickly.

Anoscopy

If the fissure is not externally visible, an anoscope (a small, lighted instrument) is used to examine deeper areas of the anal canal, ensuring an accurate diagnosis and ruling out other conditions like haemorrhoids.

Treatment Options for Anal Fissures

Non-surgical Treatment

Non-surgical methods are often recommended for treating less severe fissures. Options include:

Topical Treatments

Creams containing nitroglycerin or calcium channel blockers help relax the muscles around the anus. Relaxing these muscles reduces spasms, increases blood flow to the area, and aids in healing.

Botulinum Toxin (Botox) Injections

Botox is injected into the anal sphincter to temporarily paralyse the muscles, reducing spasms that prevent the fissure from healing. This allows the tear to heal without the constant tension of tight muscles.

Laser Therapy

Laser technology may be used to remove scar tissue and promote tissue healing. This minimally invasive method has a shorter recovery time and can provide relief when other treatments have failed.

Surgical Treatment

When non-surgical treatments are ineffective, surgical intervention may be necessary.

Lateral Internal Sphincterotomy

This procedure involves making a small incision in the internal anal sphincter to relieve muscle tension. This reduction in tension helps improve blood flow to the fissure, promoting healing. The procedure provides pain relief and is effective for chronic fissures that have not responded to other treatments.

Fissurectomy

A fissurectomy is a procedure that removes damaged tissue surrounding the fissure, including any scar tissue or unhealthy skin. This creates a cleaner area, enabling the body to regenerate new, healthy tissue more effectively. By eliminating obstructive scar tissue, the fissure can heal more efficiently, reducing the risk of recurrence.

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Preventing Recurring Anal Fissures

Maintaining healthy bowel habits is essential to prevent fissures from recurring.

A high-fibre diet and staying hydrated ensure smooth digestion, while avoiding prolonged sitting on the toilet reduces strain on the anal muscles. Regular exercise supports healthy digestion, and using stool softeners or laxatives as needed helps prevent constipation.

Managing underlying conditions, such as irritable bowel syndrome, also lowers the risk of future fissures.

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Dr. Sulaiman Bin Yusof

MbChB (Sheffield)

M.Med (Surgery)

FRCSEd (General Surgery)

蘇萊曼·尤索夫博士

Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.

Education & Specialist Training
  • MbChB(Sheffield)
  • M.Med(Surgery)
  • FRCSEd(General Surgery)

Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.

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    Frequently Asked Questions

    Can stress contribute to anal fissures?

    Stress itself does not directly cause fissures but can lead to habits like holding in bowel movements or poor digestion, which may contribute to constipation or diarrhoea, increasing the risk of developing fissures.

    Is there a risk of developing another fissure after healing?

    Yes, if the underlying causes, such as chronic constipation or diarrhoea, are not addressed, there is a possibility of developing another fissure. Preventive measures like a high-fibre diet can reduce this risk.

    Can I continue exercising if I have an anal fissure?

    Yes, light exercise is generally safe and can promote digestive health. However, avoid strenuous activities that put pressure on the abdominal area, such as heavy lifting, until the fissure has healed.

    Are there any long-term complications from anal fissures if left untreated?

    If not properly managed, chronic anal fissures can lead to persistent pain, the formation of scar tissue, or the development of an anal fistula, which may require more complex treatment.

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