Anal Fissure

Anal fissures are cracks or tears in the lining of the anus. They are often painful and may bleed. In most cases, they are treated conservatively, including the use of local anesthetics, along with dietary changes and hygiene. If conservative treatments are unsuccessful, surgical intervention may be necessary. Prevention of anal fissures includes maintaining good anal hygiene, using laxatives, and increasing fiber intake in the diet.

HOW IS IT TREATED?

Treatment for anal fissures usually begins with conservative methods. This includes:

1. Use of local anesthetics: Helps relieve pain during the bowel movement process itself.
2. Dietary changes: Increasing fiber and fluid intake softens the stool and reduces further tearing of the anus.
3. Hygiene: Maintaining good anal hygiene helps prevent infections and facilitates the healing process.
4. Medication: Commonly used medications include: nitroglycerin, calcium channel blockers, and botulinum toxin (Botox).

If conservative treatments are ineffective, surgical intervention may be necessary. There are various surgical procedures that can be utilized:

1. Sclerotherapy: This involves injecting a chemical into the fissure to seal it and prevent further bleeding.
2. Lateral internal sphincterotomy (LIS): Cutting the anal muscle that is too tight to reduce tension and facilitate healing.
3. Advancement flap: This involves redirecting tissue from the back of the anus to the front to cover the fissure and aid healing.

HOW TO PREPARE FOR SURGERY?

Preparation for anal fissure surgery involves several steps:

1. Preoperative assessment: Before surgery, the patient will need to undergo an examination by a proctologist to determine the stage of the disease and the risk of complications.
2. Exclusion of diseases: The patient may need to undergo additional tests to exclude other conditions that may affect healing.
3. Bowel cleansing: The patient will need to have an enema or use laxatives to clear the bowel before surgery.
4. Anesthesia: The patient will need to discuss with the anesthesiologist to select the appropriate anesthesia method.
5. Medications: In consultation with the doctor, some medications will be discontinued or adjusted during the surgical period.
6. Clothing: The patient will need to wear clothing that is easy to remove on the day of surgery.
7. Information about the surgery: The patient will discuss potential complications and postoperative recovery with the doctor to best prepare for the surgery.

Anal fissure surgery is a routine procedure and in most cases does not pose a significant risk to the patient. However, it is important for the patient to adequately prepare for the surgery and consult their doctor about every detail.

ARE THERE CONTRAINDICATIONS FOR SURGERY?

There are some contraindications for anal fissure surgery, including:

1. Pregnancy: Anal fissure surgery is not recommended during pregnancy as it may pose a risk to the fetus.
2. Significant anorectal infection: If the patient has a major anorectal infection, such as rectal or anal inflammation, surgery may be postponed until the infection subsides.
3. Bowel obstruction: If there is suspicion of bowel obstruction, surgery should not be performed until the obstruction is resolved.
4. Rectal bleeding: If the patient has rectal bleeding, surgery may be postponed until the cause of the bleeding is determined.
5. Increased risk of bleeding: Patients with an increased risk of bleeding, such as those with anemia or coagulopathy, may have a higher risk of complications after surgery. It is important to communicate all details with the doctor before surgery, and if necessary, adjust the intake of therapy.