Which doctor should one go to?
If you suffer from the symptoms of an anal fissure, you should urgently consult a doctor so that the symptoms can be treated early. It is especially important to minimize the extension and aggravation of the findings by early treatment and thus spare the patient unnecessary suffering. In case of an anal fissure, one should consult a specialist, a so-called proctologist.
This is a specialist who deals with diseases of the rectum. Otherwise, you can also consult a gastroenterologist. These specialists can also look for other causes of the symptoms described and possibly more serious ones, such as cancerous ulcers, or even rule them out with certainty.
How do I treat an anal fissure?
There are various therapeutic options available for the treatment of an anal fissure. First of all, a distinction must be made between an acute and a chronic anal fissure. An acute anal fissure is usually treated conservatively, i.e. without surgical intervention.
Ointments are used which have a relaxing effect on the lower sphincter muscle in the anal region and can thus facilitate bowel movement. Furthermore, the attending physician can prescribe an ointment that has an anaesthetic effect and inhibits the strong, stabbing pain. Penaten® cream has also shown success in relieving inflammation.
Intensive care should also be taken so that the wound can heal better and does not become additionally infected. Therefore the wound should be disinfected twice a day before applying the ointments and creams. It is important to make sure that before each wound treatment a thorough and extensive hand washing should be carried out so that no germs are carried away and can additionally infect the wound.
It is best to wear gloves. The doctor may also prescribe an anal dilator, which patients can use to stretch the cramped sphincter muscle and facilitate defecation. Above all, it is important to drink a lot and consume enough roughage through food.
This makes the stool softer in consistency. If the conservative treatment methods are not sufficient or if there are already strongly chronic anal fissures, in most cases surgical therapy is necessary. An acute, newly occurring anal fissure can be treated very effectively with conservative creams and ointments.
Ointments are used to relax the apparatus of the lower sphincter muscle and thus facilitate the defecation. They can have their effect due to so-called calcium antagonists and nitrates, which cause relaxation of the smooth muscle in the area of the sphincter. Ointments with a pain-relieving effect are also used.
These include preparations such as Posterisan, which can be applied to the wound in the mucous membrane area 2 to 3 times a day. They contain lidocaine, an anaesthetic which numbs the unpleasant pain by inhibiting the transmission of impulses to the existing nerve fibres in the anal region. Alternatively, the anaesthetics are also available in the form of insertable suppositories.
In addition, the treating physician can also inject an anaesthetic into the area of the anal fissure with a syringe. Symptoms such as itching, pain and burning are thus relieved and are no longer so strongly perceptible. In addition, one should ensure a balanced, fibre-rich diet and sufficient fluid intake to prevent constipation.
Acute anal fissures usually heal on their own without any consequences if the above-mentioned preparations are used and an appropriate diet is followed. If conservative measures are not sufficient to treat a fissure in the anal region, patients must in most cases undergo surgery. Since surgery is always associated with risks, patients must be informed about possible complications.
In the anal region and especially near the external sphincter, nerve fibres can be damaged. Following the operation, fecal incontinence can occur which can no longer be corrected, i.e. an inability to specifically hold back bowel movements. In addition, infections after the operation often occur, which can develop quickly due to the very high bacterial colonisation in the anal region.
They can spread further and prolong and complicate the long healing process after surgical treatment of the anal fissure. The surgical procedure is usually performed under a short anaesthetic or regional anaesthetic. Various procedures are available.
As a rule, the anal fissure and the adjacent tissue areas are completely removed so that no damaged tissue remains. During the ablation, tissue samples are also taken and sent to the pathology department in order to reliably rule out a possible cancerous process. In chronic anal fissures, coarse, protruding skin folds are usually formed, which are also removed.
In particularly difficult cases, a small part of the external sphincter muscle is sometimes removed as well, whereby a considerably high risk of the occurrence of long-term fecal incontinence must be expected here. A more recent method is the injection of Botox during the surgical treatment of an anal fissure. Botox® leads to a slackening of the external sphincter muscle and thus facilitates the defecation.
However, the disadvantage of this procedure is that it can only take effect for about 3 months and is very expensive. The healing after a surgical treatment of the anal fissure usually takes 4 – 6 weeks and can sometimes take longer. In addition, complications after the operation, such as an infection, can further prolong the healing process.
Overall, however, the healing process is different for each patient. In the first days and weeks, the wound healing process may cause unpleasant pain, which however improves significantly over the course of the operation and decreases. Due to the open healing of the wound area, a burning and weeping sensation can occur and the bowel movement also causes stinging and pulling pain in the first days.
The wound may also bleed slightly at first and be disturbing, especially when sitting. Due to the operation, the tissue is initially still very stressed and irritated. During the healing process, patients often need some patience, but in most cases the anal fissure heals completely and without damage that remains.
An acute, uncomplicated anal fissure has a good prognosis under conservative treatment. With adequate anal hygiene and the consistent application of important treatment principles, the anal fissure usually heals completely within a period of 2 to 3 weeks. Intensive and regular use of the prescribed ointments relieves the pain and the wound area is cared for, dries out and the damaged skin slowly begins to regenerate.
Since an anal fissure can reappear even after good healing, it is particularly important to continue treating the most common cause, hardened bowel movements. Through a diet rich in fibre or the addition of so-called swelling agents, such as linseed, the consistency of the stool becomes soft and smooth and can be drained more easily and without strong pressing. A permanent healing and a reduction of the risk of new anal fissures can only be achieved in the long term with soft stool.
