This usually develops as a result of passage of hard or large stools, but can sometimes also happen after severe diarrhoea. Other less common causes of fissures include inflammatory bowel disease and anal cancer.
Symptoms of anal fissure include anal pain as well as bleeding. Most anal fissures are acute fissures that heal on their own. However, some fissures persist beyond 6 weeks and are then considered chronic fissures. It is believed that chronic fissures develop because of anal muscle spasm which can then lead to poor blood supply to the muscle.
Treatment of chronic anal fissures include:
- Stools softeners and painkillers
- Medications that help to relieve anal sphincter spasm, allowing the fissure to heal
- Glycerine trinitrate ointment
- Calcium channel blocker ointment (not available in Singapore)
- Botox injection into the anal sphincters
- If the above treatment modalities fail to heal the fissure, surgery with a lateral anal sphincterotomy may be required.