Anal fissure

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© G19061707W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2019. Document for issue as handout. Unique Identifier: SURG49(19). Review date: September 2021. What is an anal fissure? Who gets anal fissures? What causes an anal What are the symptom of An anal fissure is a split or tear It can affect people of all ages fissure? anal fissure? in the skin in the and affects both men and Anal fissures can occur for no Symptoms include: (bottom of the bowel) near women equally. reason but can be brought on A sharp pain when passing to or around the anus. It can It is most common between the under certain circumstances. stools (if severe it can feel sometimes look like an open ages of 10-30. It is most often associated with like passing broken glass) sore or cut. It can be classed as: It can also be more common in: a period of . It A persistent burning pain Acute can be caused by trauma to Pregnancy after passing stools (lasting up to six weeks) or the anal canal during a bowel Passing fresh red blood Chronic Inflammatory bowel movement. (lasting six or more weeks) disease (Crohn’s disease and Often this is when the stools ulcerative ) How is anal fissure 90% of fissures develop are hard or in cases of recurrent diagnosed? posteriorly, meaning that they Certain infectious diseases diarrhoea. You may be able occur closest to the back. Long term use of certain to remember the bowel Anal fissure can usually be painkillers e.g. codeine, movement when the fissure diagnosed based on the tramadol and morphine. first occurred. symptoms that you are experiencing. Sometimes the (as these can lead to The skin around the anus fissure can be seen on external constipation) doesn’t heal very well as it is examination, and is sometimes under constant strain from Smoking may be a risk factor accompanied by a skin tag the sphincter muscles (muscles (doctors may describe this as that allow us to control bowel a sentinel pile). An internal movements) and when the area rectal exam may or may not be is sore these muscles can go into performed depending on how . painful the fissure is. Additionally the blood supply If your doctor suspects weakness to the area affected is poor and in the anal sphincter muscles they this prevents healing. may want to perform further investigations to help decide on the best treatment for you. Anal Fissure

© G19061707W. Design Services, Salford Royal NHS Foundation Trust, 1 All Rights Reserved 2019. Document for issue as handout. 2 Unique Identifier: SURG49(19). Review date: September 2021. Can I do anything to Treating anal fissure reduce the risk of getting Usually the first options for If the fissure persists and simple Calcium channel blockers a fissure? treating anal fissure are simple medications do not heal the This medication works in a There are a few thing that measures aiming to soften the fissure, further medication may similar way to GTN but it is you can do to help reduce the stools and reduce the pain. be needed to help allow the less likely to cause headaches fissure to heal: likelihood of getting a fissure, The following options are as a side effect. these measures help to keep usually effective at treating Glyceryl trinitrate (GTN) If medication is ineffective in bowel movements regular and mild anal fissures: ointment soft so they cause less trauma healing the fissure surgical GTN causes relaxation of to the anus. options may be considered: The aim of laxatives is to the sphincter muscles and Try to have a high fibre diet soften the stools making increases blood flow to the injections (you can discuss this with them easier to pass, bulk area. These two effects (Botox) your doctor or nurse) forming laxatives are used, combined allow the fissure This involves injections Keep hydrated throughout which are fibre supplements, to heal. The ointment can around the anus that the day by drinking plenty of such as Fybogel and be applied directly around temporarily paralyses the water methylcellulose. the anus. Some people may sphincter muscles which experience headaches as a Pass stools when you need stops and allow the Pain relief side effect of GTN although to, do not hold it in fissure to heal given under You can take over the these can often be controlled anaesthetic. Side effects can Stop smoking counter pain relief such as with simple painkillers like sometimes include temporary ibuprofen or paracetamol or paracetamol. Doctors often incontinence which is usually your doctor may prescribe recommend a six-week in controlling the passage of you some ointment to apply course to be used alongside wind rather than faeces. The directly to the area that stool-softeners. In studies injections may be repeated. contains lignocaine. around 2/3 patients improve with this treatment - some continued page 5 may require a second six week course.

© G19061707W. Design Services, Salford Royal NHS Foundation Trust, 3 All Rights Reserved 2019. Document for issue as handout. 4 Unique Identifier: SURG49(19). Review date: September 2021. Notes Surgical sphincterotomy This procedure is carried out under general anaesthetic. An incision is made to the sphincter muscles, reducing the muscle tension permanently and allowing the fissure to heal. It may be left open or a few small stitches placed With all surgery there are risks involved and this procedure can be complicated by bleeding,orinfection.In studies around 15% of patient may experience some form of incontinence but the majority will be in controlling the passage of wind rather than faeces.

If you require any further information or have any further concerns or questions then you can call our: Specialist Colorectal Nurses 0161 206 1249

© G19061707W. Design Services, Salford Royal NHS Foundation Trust, 5 All Rights Reserved 2019. Document for issue as handout. 6 Unique Identifier: SURG49(19). Review date: September 2021. © G19061707W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2019 This document MUST NOT be photocopied

Information Leaflet Control Policy: Unique Identifier: SURG49(19) Review Date: September 2021

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