What symptoms can I expect after the
surgery?
When can I
activity?
return to normal
After the surgery there may be some
discomfort from the incision. The fissure
will still be there, however the
discomfort or pain in the area is
different. There may also be some
minor bleeding. With a combination of a
high fibre diet and stool softeners then
the fissure should be heal up over the
next few weeks. The pain often resolves
over the next few days. If the problem
persists then further investigations may
be require as directed by the surgeon.
This varies from patient to patient. After
the surgery you will be prescribed pain
killers
for
any
post-operative
discomfort. A high fibre diet is
recommended and taking warm baths
may soothe the fissure and operated
area. In the majority of patients a return
to full activity should occur over the
next few days after surgery. A full return
to work will depend upon the
occupation of the patient involved. If
there is persistent pain then you should
consult your doctor for further
assessment.
Anal Fissure
Department of
Colorectal Surgery
Will the fissure come back?
The fissure is often due to a hard dry
bowel motion being passed resulting in a
tear at the anal margin. If the patient
continues to have such bowel motions
then further fissures may occur. It is
therefore important to correct the bowel
habits if one is to avoid any future
problems. In cases where the fissure fails
to heal after surgery then they should be
reassessed. In those small number of
patients where the fissure fails to heal or
comes back then further surgery may be
required to correct the problem.
THE ADELAIDE & MEATH
HOSPITAL, DUBLIN
Produced by:
Mr Paul Neary MD, FRCSI
Consultant Colorectal Surgeon
Department of Colorectal Surgery
Adelaide and Meath Hospital
INCORPORATING THE NATIONAL
CHILDRENS HOSPITAL
Statement of Values
Respect - Caring Openness - Partnership –
Teamwork, Fairness &
Equality
What is an anal fissure?
Can they cause cancer?
What creams are used?
An anal fissure is a small tear that occurs
at the anal margin. This tear is usually
about one centimetre (half inch) in size
and runs into the anus. They can cause
severe pain and often bright red bleeding
when passing a bowel motion.
There is no connection between a
fissure and an anal cancer. Fissures do
not cause cancer. Patients with an anal
fissure however may also develop a
bowel cancer independently of having
a fissure. As bowel cancers can also
present with bleeding from the anus, it
is advisable that the patient should be
fully assessed if bleeding should occur.
Your doctor may prescribe a topical
cream to be applied to the anal area
such as GTN 0.2% ointment. The
cream has been shown to result in
healing of fissures over a six week
period. It may however cause
headaches if too much is applied.
How do they occur?
In the majority of cases the fissure is
caused by passing a bulky hard dry
bowel motion at some stage when a
patient may be a little constipated. This
is the cause in the majority of patients
seen and termed an acute fissure. In a
small number of cases the fissure is part
of other disease processes such as Crohns
disease or underlying medical conditions.
In these cases the fissure is often present
for a long time and termed a chronic
fissure.
What are the symptoms of an anal
fissure?
Patients with fissures usually present
with pain and bleeding from the anal
area. The pain can be quite severe and
the blood is usually bright red in colour.
The pain is often far worse when the
patient in passing a bowel motion.
Because of the pain involved then
patients will often try and avoid moving
their bowels to get relief.
How are they treated?
The majority of acute fissures heal
without surgery. Patients are advised
to improve their bowel habit to avoid
constipation. This involves a high fibre
diet, stool softeners and drinking
plenty of water. Using warm baths to
get relief may also help. In the event of
the fissure not healing then a variety of
topical creams may be used in order to
heal the fissure. If these are
unsuccessful in healing the fissure then
surgery may be required.
What does the surgery involve?
The surgery involved is often
performed as a day case procedure.
Much of the pain associated with the
fissure is thought to be related to
spasm of the muscle in the area. The
surgery involves cutting a portion of
the anal muscle but this generally does
not result in any leakage thereafter.
The surgery does not remove the
fissure however is aimed at allowing
the fissure to heal up afterwards. This
may be performed under general
anaesthesia and sometimes involves
absorbable stitches. The surgery is
called a lateral internal anal
sphincterotomy. In cases of a chronic
fissure or in cases where the fissure is
due to more complex disease then
other surgical options may be used.
The specific aspects of the surgery will
be explained in detail by the surgeon
prior to the procedure being
undertaken.