Anal fissure – a small problem with great pain
An anal fissure is a small tear in the mucous membrane of the anal canal – but the consequences are often anything but minor. Severe, stabbing pain during bowel movements, burning, bleeding and muscle cramps mean that many sufferers avoid going to the toilet, which in turn exacerbates the problem.
While acute anal fissures often heal on their own or with conservative therapy within a few weeks, chronic anal fissures often persist for months or years. When is an operation necessary? What surgical methods are available? And what are the long-term chances of success?
This article clarifies all the important questions relating to the treatment of chronic anal fissures and shows when surgery is the best solution.
What is an anal fissure? Causes, symptoms and progression
An anal fissure is an elongated tear in the sensitive anal mucosa, usually at the posterior midline of the anal canal. It often occurs as a result of hard bowel movements, heavy pushing or diarrhea.
Causes of an anal fissure:
- Constipation & hard stools – mainly caused by pushing too hard
- Chronic diarrhea – irritates the mucous membrane and promotes microcracks
- Increased sphincter pressure (hypertonus of the internal sphincter) – prevents healing
- Lack of blood flow to the anal region – worsens wound healing
- Hemorrhoids, irritable bowel syndrome, Crohn’s disease – concomitant diseases that promote anal fissures
Facts about anal fissure:
- Around 10% of all adults experience an anal fissure at least once in their lives.
- Men and women are affected equally often.
- Athletes (cyclists, runners), office workers and pregnant women have an increased risk.
Acute vs. chronic anal fissure: what is the difference?
1. duration
- Acute anal fissure: Less than 6 weeks
- Chronic anal fissure: Longer than 6 weeks
2. pain
- Acute anal fissure: Stinging, especially during bowel movement
- Chronic anal fissure: Constant pain, also between bowel movements
3. bleeding
- Acute anal fissure: Fresh, bright red blood
- Chronic anal fissure: Recurrent bleeding
4. wound healing
- Acute anal fissure: Mostly spontaneous
- Chronic anal fissure: Slow or no healing
5. changes
- Acute anal fissure: None or only minimal
- Chronic anal fissure: Hypertrophic anal papillae, scarred fissure edges, mariscus
Note: A chronic anal fissure often persists for months and requires targeted treatment.
Conservative treatment: When can surgery be avoided?
Before considering surgery, non-surgical treatments should be tried first:
Local medication (ointments & suppositories)
- Nitroglycerin ointments (Rectogesic®) → Reduce sphincter pressure
- Calcium channel blockers (diltiazem, nifedipine) → Promote blood circulation
- Cortisone suppositories → Against inflammation
- Lidocaine ointments → Analgesic
Stool regulation & nutrition
- High-fiber diet → Soft stool prevents new cracks
- At least 2-3 liters of water daily
- Mild laxatives (macrogol, lactulose) → If constipation is present
Botox injections – an alternative to surgery?
- Botox relaxes the sphincter muscle for approx. 3-6 months, promotes healing and relieves pain.
- Success rate: 60-80 % cure
Note: If ointments, Botox etc. do not help, the only remaining permanent solution is surgery.
When is surgery unavoidable?
Surgery is recommended if:
- The fissure has been present for more than 8 weeks and does not heal
- Severe pain persists despite conservative therapy
- Additional problems occur (fistula formation, scars, abscesses)
- The sphincter muscle is permanently cramped and disrupts the blood flow
Surgery can provide a permanent cure and significantly improve the quality of life.
What surgical methods are available?
Fissurectomy – removal of the fissure
- Removal of the scarred tissue
- Success rate: 90 % cure
- Can usually be performed on an outpatient basis
Ideal for chronic anal fissures without extreme sphincter pressure.
Lateral sphincterotomy (LIS) – relaxation of the sphincter muscle
- Part of the internal sphincter is split → Pressure relief
- Success rate: 95 % cure
- Minimally invasive with a small incision
Very effective, but with minimal risk of mild faecal incontinence (<5%)
Minimally invasive laser treatment (FiLaC – Fissure Laser Closure)
- Gentle laser therapy to obliterate the fissure
- Faster healing, less pain
Ideal for patients with high sphincter function
Healing after the operation & aftercare
- Slight pain possible, but much better than before the operation!
- Duration of incapacity for work: 3-10 days
- Daily sitz baths with camomile or oak bark promote healing
- Soft stools through a high-fiber diet & water intake
- Light exercise (walks) promotes blood circulation
Note: Most patients are completely symptom-free after 4-6 weeks.
Surgery as the last option – but often the best solution!
A chronic anal fissure can cause months of pain. If conservative therapies fail, surgery is often the only permanent solution.
The specialist will decide which method is most suitable in an individual examination.
VenaZiel Berlin MVZ – Your experts for minimally invasive proctology! Make an appointment now.
