Anal Fissures

Abnormal

Normal

DESCRIPTIONS
* This is a cut (ulcer or Laceration) inside the anus. The usual cause is trauma to the anus because of a strained bowel movement, hard bowel movement, or high internal sphincter tone (the area that allows stool to pass stays tense, obstructing proper passage).


SYMPTOMS
* Severe tearing pain during a bowel movement
* Throbbing pain in anus following a bowel movement
* Blood on toilet paper or around the bowel movement

CAUSE
* Constipation
* Constant irritation from stool in diapers of babies or constant wiping in all others
* Scratching due to infections (e.g., pinworm) or skin conditions (e.g., dry skin, Eczema)
* Straining
* High internal sphincter tone (explained above)

HOW THE DIAGNOSIS IS MADE
* Visual inspection by physician

TREATMENT
* Sitz baths
* Fiber supplements
* Stool softeners
* Topical anesthetics (Mesalamine suppositories)
* Topical nitroglycerin Ointment (this is at 10% the strength used for angina) -- relaxes the internal sphincter
* Botulism toxin injection -- also relaxes the internal sphincter
* Partial lateral internal sphincterotomy -- the sphincter is partially cut in order to relax it

SIMILAR CONDITIONS
* Thrombosed external hemorrhoid
* Solitary rectal fissure
* Cancer of the Anus

MISCELLANEOUS
* Tests That May Be Done

1. Anoscope
2. Flexible Sigmoidoscopy