How is an anal fissure diagnosed?
Your doctor will most likely inquire about your medical history and do a physical examination, which will include an examination of the anal region. The tear might be visible, but unfortunately, it is not always visible. Doing a digital examination might be extremely uncomfortable for the patient, and if the index of suspicion is high and conservative measures fail, examination under anaesthetic might be required. If a fissure lasts longer than eight weeks, it is considered chronic. There are multiple causes of anal fissure, and these can include:
- Chronic constipation
- Underlying medical condition
- Chron's disease
- Ulcerative colitis
- Anal cancer
- Leukaemia
- Infectious diseases
Anal fissure treatment
With conservative measures aiming at keeping the stool soft, such as increasing fibre and fluid intake, anal fissures can heal in a few weeks. Soaking for 10 to 20 minutes in warm water many times a day, especially after bowel motions, can help relax the sphincter and encourage healing. If your symptoms don't go away, you'll probably require definitive treatment. I will usually try medical treatment first and only consider surgery if you have a chronic anal fissure that is resistant to previous therapies or if your symptoms are severe.
As the digital examination is extremely painful with an anal fissure, Dr Bruwer usually advises an examination under general anaesthetic if non-surgical treatment fails.
His surgical treatment of choice is a lateral internal sphincterotomy (LIS) operation. This involves confirming the diagnosis with an examination under anaesthetic and then cutting a small piece of the anal sphincter muscle to relieve spasms and improve recovery. The alternative procedure is the so-called Lords procedure. This involves dilatation of the anal sphincter. Dr Bruwer does not perform this procedure. The outcome is not as good, and there is a higher risk of incontinence.