Fissures result from the stretching of your anal mucosa beyond its normal capacity. This often happens when stools are hard due to constipation. Once the tear happens, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. This causes severe pain. The spasm also pulls the edges of the fissure apart, making it difficult for your wound to heal.
New Protocol to Treat Anal Fissures | Columbia University Department of Surgery
An anal sphincter is a group of muscles at the end of the rectum that surrounds the anus and controls the release of stool, thereby maintaining continence. There are two sphincter muscles: one is internal and one is external. The external muscle helps maintain continence and keep stool in the rectum. If there is a loss of muscle control in the sphincter, incontinence may occur. The inner muscle is not under voluntary control but rather is controlled by the autonomic nervous system. The external sphincter can be voluntarily controlled, meaning it can be clenched and unclenched.
Anal Fissures: Management and Treatment
An anal fissure is a small cut or tear in the lining of the anus. The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times, the fissure can be deep enough to expose the muscle tissue underneath. In most cases, the tear heals on its own within four to six weeks. Certain treatments can promote healing and help relieve discomfort, including stool softeners and topical pain relievers.
The goal of anal fissure treatment is to lower the pressure on the anal canal by making stools soft, and to ease discomfort and bleeding. Conservative treatments are tried first and include one or more of the following:. These practices heal most fissures 80 to 90 percent within several weeks to several months. However, when treatments fail and anal fissures persist or come back, other measures can be tried, including:.