But the inner sphincter is not. This muscle is under pressure, or tension, all of the time. If the pressure increases too much, it can cause spasm and reduce blood flow to the anus, leading to a fissure. This pressure can also keep a fissure from healing.
Surgery If your fissure does not heal in four weeks or you have had your fissure for a long time you may need surgery. The surgeon will cut the fissure open in a procedure called a sphincterotomy. This will hurt initially but the fissure will be gone and probably won't come back.
If your symptoms do not improve within a week or 2, the GP may prescribe a medicine called glyceryl trinitrate (GTN), an ointment applied to the anal canal, usually twice a day. GTN works by expanding blood vessels in and around the anus, increasing the blood supply to the fissure and helping it heal faster.
Do fissures ever fully heal? Most acute anal fissures heal within a few weeks, similar to other minor wounds or cuts. Even 35% of chronic anal fissures heal, even temporarily. However, it is not uncommon for a fully healed fissure to recur after another injury or hard bowel movement.
A more recent, acute anal fissure looks like a fresh tear, somewhat like a paper cut. A long-lasting, also called chronic, anal fissure likely has a deeper tear. It also may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.
POST-TREATMENT PROGNOSIS
Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing. Botox® injections are associated with healing of chronic anal fissures in 50% to 80% of patients. Sphincterotomy is successful in more than 90% of patients.
Acute fissures can become chronic, and sentinel pile can result. A permanent skin tag can result, and fistulas may form.
An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment. Recurrence. Once you've experienced an anal fissure, you are prone to having another one.
The pain may cause you to hold in your bowel movements, making you constipated. This can lead you to have a harder bowel movement, which can make your anal fissure worse.
Petroleum jelly, zinc oxide, 1% hydrocortisone cream, and products like Preparation H can help soothe the area. Instead of toilet paper, use alcohol-free baby wipes that are gentler on the area. Sitz baths can help heal fissures and make you feel better.
Most anal fissures are idiopathic and are located in the posterior midline. However, some fissures may be associated with systemic diseases, infections or malignancy [1, 2]. Squamous cell carcinoma of the anus (SCCA) commonly presents with bleeding and anal pain [3].
“Some people—if they get a tear—will heal up on their own and will be fine. For others, the fissure doesn't heal properly on its own. Every time they bottom, the fissure will break open again, and the fissure remains chronically open. This can be quite painful.”
If someone has a chronic fissure, it is thought that the reason it has not healed is that the ring muscle (sphincter) that goes around the anus (back passage) has become so tense that the flow of blood to the lining of the anus is reduced.
Basic difference of fissure & fistula
Generally, fissures can get cured in a few days or few weeks, often without even needing any treatment. They are not known to cause much complication. Contradictory to that, leaving fistulas untreated can result in complications.
Piles are mainly the swollen blood vessels while fissures are kind of cracks and fistulas are an opening of a cavity. Piles are mostly painless and unnoticeable. Fissures cause a lot of pain. In the case of fistulas, pus is discharged out of the anal area.
In the final stage of fissure healing, epithelialization and maturation occur. Epithelial cells migrate and cover the wound, forming a new layer of skin. The tissue becomes stronger and more resilient, reducing the risk of reinjury. At this point, individuals may experience minimal to no pain or discomfort.
There is a significant chance that you will recover well after this operation because it is safe. But there are some risks associated with fissure surgery, some of them include: Incontinence: This is quite unlikely to happen if you have botox therapy.
Typically, a doctor can diagnose anal fissures through a simple visual examination. If the doctor believes further tests may help to determine an underlying condition, patients may undergo tests including: Colonoscopy, in which a lighted, flexible tube looks at the inner lining of the colon to check for inflammation.
The internal sphincter muscle contributes to baseline and resting continence. Spasm of this muscle results in severe anal pain and constricts blood flow to the fissure area.
Anusol Cream is a medicine which is used to relieve the swelling, itch and irritation of internal and external piles (haemorrhoids) and other minor ano-rectal conditions such as anal itching and fissures. It can be used post-operatively following ano-rectal surgery.
Anal fissures can make life difficult for people but making some lifestyle changes and following self-help tips can help you relieve the symptoms. Measures like drinking plenty of water and involving high fibre in your diet help by relieving constipation and giving the fissures a chance to heal on their own.
Causes of anal discharge
Mucus-based discharge may be caused by: Infection due to food-poisoning, bacteria or parasites. An abscess due to infection or an anal fistula – a channel that can develop between the end of your bowel and anus after an abscess.