Any tear in the muscles (sphincters) can cause an anal fissure. This causes a spasm in the inner sphincter leading to gaping in the fissure. Due to this, the blood supply to the area is sealed off causing pain and delayed healing. This spasm causes further tear during defecation, hence, preventing complete healing of the fissure. Anal fissures mostly develop in people with constipation. Other causes include:

• • Chronic diarrhoea
  • Irregular and poor bowel habits
  • Pregnancy and childbirth
  • Increased pressure (tone) of the anal sphincter muscles 
  • Inserting objects into the anus
  • Medical conditions like Crohn’s disease and ulcerative colitis (inflammatory bowel disease), tuberculosis (infectious disease), gonorrhoea and syphilis, (sexually transmitted diseases), etc.
  • Infections and injury in the anus/anal canal
  • Anal cancers

The symptoms of an anal fissure consists of:

• Pain while passing stools 
• Burning and itching sensation while passing stools
• Difficulty in passing stools
• Tear in the skin around your anus 
• Blood present in the stools or on toilet paper while wiping (bright red in colour).

In most cases, the fissure heals within a week to 10 days. If the symptoms persist, it is recommended to visit your doctor for correct diagnosis and early treatment.

Your doctor will ask your medical history and perform a physical examination of your anal region to look for tears, swelling, ulcers (open sores) and bleeding. Few other tests may be advised to reach the diagnosis:

• Rectal examination with an anoscope: A thin tube called an anoscope is gently inserted into your rectum to check for tears in the anus or rectum. 
• Sigmoidoscopy: A procedure to look at the rectum and the last part of the large intestine (colon) using an instrument called a sigmoidoscope.
• Colonoscopy: A procedure to examine the inside of the colon and rectum, using an instrument called a colonoscope.

An anal fissure can be managed through non-surgical and surgical methods but most anal fissures (acute fissures) do not require surgeries and can be managed at home by medical treatments.

• Non-surgical Management:
  • Drink more fluids and increase your fibre intake to soften your stools
  • Take a sitz bath
  • Clean and dry your anus gently after going to the toilet
  • Avoid straining while passing stools
  • Medical treatments. Your doctor may prescribe some medications to help in passing your stools easily, painkillers and antibiotics to ease your pain and inflammation and other medications to relax your sphincters.

• Surgical Management: Surgery is advised if your anal fissure is causing persistent pain and bleeding (chronic fissure) that does not heal or respond to home remedies or medications. The procedure is called fissurectomy in which the damaged skin around the anus is removed.

Discuss your medical history with your doctor and inform them about any medications that you are currently taking and in case you have an allergy to any drugs. You may need to stop medications such as blood thinners (drugs taken to prevent the formation of blood clots) a few days before the surgery, as these can cause excess bleeding during and after the procedure.

• At the hospital:

Sphincterotomy is an outpatient procedure and you can return home the same day of the procedure. You will be kept under observation for 1-2 hours after the procedure. On discharge, your doctor will give you the necessary instructions to follow during the recovery period.

• At home: 
  • Take ample rest.
  • Bathe after 24 hours of the surgery. Have a bath every time you go to pass stools to prevent infection.
  • You may experience bleeding or discharge in your stool or on the toilet paper for around 10 days after the procedure. There is no need to worry as it will resolve on its own after 10 days. Clean the area with water and keep it dry.
  • Drink plenty of water and eat fruits and vegetables to make your stools soft which will prevent constipation.
  • Do not eat fried foods, dairy products and aerated beverages too often as they may cause constipation.
  • Avoid straining while passing stools.
  • Avoid strenuous activities for a few days after the procedure. 
  • Take your medications regularly as advised by your doctor.