Fissure surgery

Pain during bowel movement and fresh blood on the toilet could indicate the development of a rectal crack – fissure. Although this is not a life-threatening problem, it hurts and is very bothersome. It’s time to understand how to treat it.

What is a fissure and what causes it?

A fissure is a crack in the rectal skin, right at the opening of the rectum. This fissure is a wound in all aspects, which usually causes unpleasant pain during bowel movement and sometime after it. Sometimes, when the fissure is very serious, these pains will be felt unrelated to bowel movement.

The causes for fissure are not completely known, but we do know today of factors that encourage its creation and contribute to it, among them:

• Prolonged constipation
• Difficult defecation
• Frequent diarrhea
• Problem with blood flow to the area
• Various intestine diseases
• Insertion of a foreign body to the anus (including having anal sex)
• Pregnancy and birth

How to identify a fissure?

Since this is an area that is, of course, difficult to observe directly, the signs for fissure development are mostly sensory and those relying on visual findings after defecation.  Thus, sharp and acute pain in the anus area, as well as blood in the toilet – fresh blood that isn’t “mixed” with the actual feces – might indicate fissure development. A yellow secretion on the toilet paper also indicates fissure cases.

Furthermore: if the pain grows stronger during defecation or appears only during and after it, the chances that this is a fissure increase. Itching or irritation around the anus might also indicate a fissure, as this is a wound that tends to get infected easily due to its surroundings.

How to distinguish hemorrhoids and fissure?

Many tend to confuse the 2 – mostly because they develop in the same region of the body and might cause similar symptoms – but hemorrhoids and fissure aren’t the same things. Hemorrhoids are expanded veins that might cause bleeding, whereas fissure, as said, is a wound or lesion in the anus.
However, advanced hemorrhoids might sometimes contribute to a fissure, in which case both diseases would appear together. A doctor rectally examining the patient, while looking and feeling, could distinguish between fissure and hemorrhoids, and usually without great difficulty. A proper diagnosis and referral to a proctologist are vital for this exact reason: to allow quick treatment and recovery for those suffering from those diseases.

How to treat fissure?

Fissure treatment is necessary not because it is life-threatening, God forbid – but because it severely harms the quality of life. If you are also suffering from this problem, or suspect you have a fissure, don’t delay in checking it out: the wound doesn’t heal on its own, usually, due to the small blood flow to the area, and it might get infected easily, as noted earlier.

Fissure treatment today is first and foremost conservative – meaning without surgery. There are several ways to do that, among them: switching to soft diet, leading to soft defecations and ease on the pressure of the entire area, and of course the fissure; soaking baths, which might ease the pain and soften the skin in the area; numbing ointments to ease the pain and relax the bowels; Botox injection (localized numbing agent) to aid in relaxing the area and reducing pain.

If the conservative approaches don’t help to improve the situation or if the fissure is very serious – the surgery will be decided (this decision will mostly be made after a follow-up of several weeks). As the doctors would explain to you, there are 4 main ways to perform the surgery:

• Making an incision in the anus: this is a tiny incision that will allow relaxation of the rectal muscles and allow the relaxation of the painful fissure. It should be noted that this surgery sometimes causes a partial loss of bowel control, whether temporary (several months) or permanently (rare cases)
• Anal dilation: this is an option that doctors use relatively infrequently today since it’s considered less monitored, but it’s also possible. In this surgery, a relaxation of the rectal muscles is performed by dilating the anus via special balloon or manually
• Use of an anal flap: tissue from the anus is transplanted where the painful fissure is, and above it. This way, the fissure is “covered” and can heal better, as it’s protected from friction and infections
• Fissure resection: in certain surgeries, a complete resection of the fissure is performed, so underneath it, a group of healthy tissue is exposed, which would heal quicker.

It should be noted that fissure surgeries are relatively very simple, and usually, don’t cause unnecessary complications and are considered to have high success rates. In many cases, the fissure is also accompanied by hemorrhoids, then the staff would consider a combined treatment for the fissure and hemorrhoids in one surgical procedure. After consultation with an expert proctologist of the Herzliya Medical Center private hospital, you could know your condition exactly and understand what’s the required treatment and decide on the appropriate surgery method, if indeed there is a need for a surgical procedure in your case.