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.
Senior Consultant Colorectal Surgeon
MBBS, MMed (Surgery), FAMS, FRCSEd
Dr Tan Wah Siew was senior consultant surgeon at the Department of Colorectal Surgery, Singapore General Hospital (SGH) prior to her move to private practice. She was the first female consultant colorectal surgeon in the history of SGH, and was one of the earliest female surgeons in Singapore to be trained in robotic colorectal surgery.
She graduated from the Faculty of Medicine, National University of Singapore in 2003 and completed her Advanced Surgical Training in General and Colorectal Surgery at SGH in 2011. In 2013, she completed a one year Ministry of Health sponsored Healthcare Manpower Development Plan Fellowship (HMDP) at St. James University Hospital in Leeds, United Kingdom. While there, she trained in minimally invasive and robotic colorectal surgery for colorectal cancer, surgery for inflammatory bowel disease as well as treatment of locally advanced rectal cancers and recurrent pelvic cancers requiring removal of multiple organs and/or pelvic exenterations.