Anal Fissures (Anal Cracks)

Anal fissures, also known as anal cracks, refer to tears that occur in the lining of the anus. The most common causes of anal fissures can be listed as constipation, excessive straining, and frequent defecation. Bleeding may be observed due to small tears in the skin covering the entrance of the anus. Often resulting from hard stool, i.e., constipation, anal fissures are characterized by post-toilet pain, cracks around the anus, and bleeding from the anus. Op. Dr. İbrahim Çolhan, who serves his patients in Adana, explained what is curious about the treatment of anal fissures caused by prolonged diarrhea and constipation.

What is an Anal Fissure (Anal Crack)?

An anal fissure appears as tears in the thin tissue covering the anus due to long-term constipation or excessive straining. These cracks in the anal region usually occur in the anoderm, which is the weakest point of the anus. When an anal fissure occurs, the healing mechanism, as in every part of the body, is activated. While cells are in the process of renewing and repairing themselves, repeated defecation can lead to the wound reopening.

What Causes Anal Fissures (Anal Cracks)?

The main cause of anal fissures is long-term complaints of constipation. However, long-term pregnancy, bowel diseases, sexually transmitted infections, diarrhea, or dehydration can also result in anal fissures.

If we need to list the causes of anal fissures:

• Large and hard stools
• Chronic constipation
• Diarrhea
• Pregnancy and childbirth
• Inflammatory bowel diseases
• Sexually transmitted infections
• Increased tension in the anal canal and becoming sensitive to tearing

What are the Symptoms of Anal Fissures (Anal Cracks)?

The most common complaint in cases of anal fissures is pain in the anal region after using the toilet. In addition, the appearance of cracks in the anal region, itching, and bleeding are also considered symptoms of anal fissures.

If we need to list the symptoms of an anal fissure:

• Feeling pain like a glass cut during defecation
• Bleeding in the area due to the wound reopening
• Seeing cracks around the anus
• Seeing a lump next to the anal fissure
• Irritation of the torn area
• Itching
• Difficulty defecating

How are Anal Fissures (Anal Cracks) Diagnosed?

Following the complaints expressed by individuals experiencing anal fissure problems, the doctor performs a comprehensive physical examination and can diagnose an anal fissure. In individuals over 40 years of age, rectosigmoidoscopy and colonoscopy examinations may be used to rule out other disease possibilities.

How is an Anal Fissure (Anal Crack) Examination Performed?

During an anal fissure examination, the patient bends over on their knees, and the doctor checks the anal area. By examining the problematic skin, an anal fissure can be diagnosed.

How are Anal Fissures (Anal Cracks) Treated?

Both surgical and non-surgical procedures are used in the treatment of anal fissures, but the definitive treatment method is surgical intervention. Anal fissure treatment is applied as follows:

Firstly, the patient is recommended stool softeners and warm sitz baths. These measures provide temporary or sometimes permanent relief for the patient.

If treatment cannot be achieved with these applications, results are sought with local corticosteroid cream applications.

Subsequently, if the patient's complaints still persist, medication is applied to relax the muscles in the anal region. The relaxation of the smooth muscles in the area relieves the patient. However, these medications have a side effect such as headaches. Therefore, these medications are not suitable for long-term use.

Botox injection can be applied to the muscles in the area for the treatment of anal fissures. However, even if this treatment alleviates the symptoms, it needs to be repeated every six to eight months.

For the most effective and definitive treatment, surgical intervention is resorted to. In this procedure, the smooth muscle of the intestine needs to be cut to the size of the fissure. Treatment is provided in 97% of these patients. Surgical treatment of anal fissures is called lateral internal sphincterotomy.

How is Anal Fissure (Anal Crack) Surgery Performed?

Surgical treatment of anal fissure cases is performed as follows:

• First, the patient scheduled for surgery must stop eating six to eight hours before the operation.
• After the examinations performed by the anesthesiologist, the anesthesia method to be applied to the patient is decided. The operation can be performed under general anesthesia or spinal anesthesia.
• During surgery, a minimal incision of about one and a half cm is made at the edge of the anus. Then, the part of the intestine that causes the fissure is cut to a size of 10 to 15 mm. The decision whether to stitch the opened wound or not is made according to the situation.
• Anal fissure surgery can be completed within ten to twenty minutes.
• Within 4 to 6 hours after the operation, the patient can get up. Patients can continue their normal diet after surgery. The patient is taught how to perform warm sitz baths. Patients do not experience severe pain complaints after surgery. Although the pain experienced by the patient is minimal, severe pain can rarely be seen. In such cases, the surgical area may need to be re-examined.
• After anal fissure surgeries, a fistula or abscess may form in the wound area in the future. However, it should be noted that this is an extremely rare complication.
• Patients can usually be discharged from the hospital on the same day after surgery.
• Approximately two to three days after the operation, the patient can return to work and their normal daily life.
• However, patients need to continue sitz baths for about fifteen days.