Anal fissure
What is an anal fissure and how does the problem occur?
An anal fissure is a split in the skin of the anal canal that usually starts 2mm below the dentate line and goes down to the anal opening. The pathophysiology of the fissure is thought to be related to trauma (passage of hard stool or associated with prolonged diarrhea). A tear in the anoderm causes spasm of the internal anal swinger resulting in pain, enlargement of the tear, and decreased blood perfusion of the anoderm. This cycle: pain, spasm, ischemia leads to the development of a wound that heals poorly. Usually located posteriorly, 10 to 15% of fissures occur centrally anteriorly, and less than 1% of fissures occur off the midline. The main symptoms are tearing pain and hematochezia. The pain can last for several hours, and the diagnosis is made by examination, anoscopy and rectoscopy. It can be acute and chronic. It is an acute superficial tear and almost always heals with medical care. Chronic fissures develop ulceration and bulging edges with visible fibers of the internal anal swinger.
Treatment of anal fissure
Treatment consists of interrupting the pain cycle of ischemia spasm. Most often, it comes down to the application of ointments and creams with stool regulation. Surgical treatment is reserved for chronic fissures where medical treatment has failed. Includes excisions with lateral internal swingterectomy. Recurrences occur in less than 10%, and the risk of incontinence ranges from 5 to 15%.
Dr. ALEKSANDAR OGNJENOVIĆ
GENERAL SURGERY SPECIALIST