The anal fissure is a very painful tear in the mucous membrane of the anus. It is one of the most common causes of sudden anal pain. Both sexes are affected roughly equally, but younger adults are more affected than older people. For a long time it was assumed that mechanical damage to the mucous membrane caused by hard stool was the main cause of the tear. The injury leads to severe pain and cramping of the pelvic floor. The latter, in turn, increases the pain and fear during the next bowel movement (Circulus vitiosus). Today it is assumed that the cause of the formation of a fissure is more complicated and depends on several factors (injury, mucosal blood flow, etc.). The anal fissure can be classified into two forms based on its duration, namely into an acute and a chronic form, and based on its pathophysiological origin into a “primary” or “secondary” fissure.
The treatment of the fissure is usually a step-by-step therapy from dietary measures to drug therapies and surgical procedures.
Non-surgical procedures are used in the first 6-8 weeks:
- Increase the amount of water you drink and the amount of fiber
- Local application of ointments (nitroglycerin, calcium channel blockers)
- Injection therapy with botulinum toxin
Surgical therapy is used for chronic anal fissures (> 6 weeks):
- Cutting out the fissure (fissurectomy)
- Flap plastic (V-Y Anoplasty)