Anal fissure – laser removal

Symptoms of anal fissure

A characteristic symptom of anal fissure is the formation of a wound that causes severe pain and bleeding when passing stool. The wound is formed along the axis of the anal canal. In most cases (85%), it located on the back side, less often (10%) on the vaginal side in women and the scrotum in men, or elsewhere in the anal circumference (5%). In certain cases, more than one fissure is formed.

Pain is usually experiences when the stool passes through the anus and a few minutes following defecation. It usually subsides on its own. Sometimes pain is accompanied by an itching, burning sensation or discomfort in the anal and perineal area.

Another symptoms of anal fissure is bleeding, which usually occurs during bowel movement. Traces of blood are left on the toilet paper. In case of heavy bleeding, which continues after defecation, traces are also visible on underwear. Pain and bleeding are most severe in the first few days of the disease. Then, the symptoms subside. A strong feeling of pushing when defecating is also typical of this condition.

Types of anal fissure

There are two types of anal fissure:

• Acute form of anal fissure (fresh) : it is accompanied by a burning sensation that appears suddenly after passing stool, which may persist for up to several hours after defecation. The pain is sometimes accompanied by bleeding. The acute form of anal fissure can sometimes heal on its own after a few days. When symptoms persist for at least six weeks or longer, this may be an indication of the chronic form of anal fissure.
• Chronic form of anal fissure (old): occurs when the bottom of the fissure on the internal sphincter is covered by scar tissue. The wound edges move away from each other and become thickened. The internal anal sphincter muscle is irritated by the formed fissure, which causes it to contract involuntarily. This can make it difficult to relax the muscle even when passing stool.

When the wound overgrows, an anal fissure develops. Nodules, or pseudopolyps, form on the outside of the fissure and an overgrown anal papilla grows on the inside.

Causes of anal fissure

The immediate cause of anal fissure is not clear. There is a theory that it may be caused by mechanical trauma. When excessively large or hard pieces of stool pass through the anal canal, the epithelial tissue covering it (anodermis) is torn.

Another reason may be diarrhoea containing digestive juices, which irritates the anal area and makes it susceptible to rupture from within. It has also been proven that increased tension of the internal sphincter may contribute to anal fissure formation.

Risk factors for anal fissure

The following risk factors for anal fissure can be identified:

• frequent anal sex,
• chronic constipation,
• hard, compact stool,
• prolonged labour with episiotomy or membrane rupture,
• infection of the anal glands,
• intestinal ulcers,
• Crohn’s disease.

Diagnosis of anal fissure

Anal fissure can be diagnosed on the basis of the symptoms present at the patient interview stage. The diagnosis is confirmed by a digital rectal examination.

In some cases, additional examination may be necessary, including rectoscopy, anoscopy, sigmoidoscopy, colonoscopy or rectal biopsy to exclude possible inflammatory processes in the intestines, systemic diseases or tumours. The choice of additional examination depends on the patient’s medical history and the results of the basic examination.

Treatment of anal fissure

The initial treatment of anal fissure is conservative, which in most cases allows to successfully cure the condition. This is related to the fact that anal fissure is caused by an excessive contraction of the muscle. The aim of conservative treatment is, therefore, reducing the tension, for example by using an ointment containing muscle-relaxing agents, such as nitroglycerine or nifedipine. Remedies facilitating bowel movements are also used. An important aspect is also diet modification to avoid hard stools and constipation. Eating fibre-rich foods and taking plenty of fluids is recommended. In chronic anal fissure, this type of treatment works well in about 10-15% of cases.

In more advanced stages of the condition, it may be necessary to inject botulinum toxin into the anal sphincter. The resulting muscle relaxation lasts for about 2-4 months, allowing the wound to heal. The success rate of this method is estimated at 90% for acute anal fissure and 60-70% for chronic anal fissure.

Surgical treatment of anal fissure

If more conservative treatment methods yield poor results, the patient may require surgery. At Mediqpol, we offer laser treatment procedure with Leonardo Dual Biolitec, which uses unique patented radial fibre optics that vaporise the skin tissues in a controlled manner. The procedure involves inserting a speculum into the anus and vaporising the pathological tissue.

It is one of the safest methods, which allows to reduce the risk of uncontrolled bleeding and at the same time minimises the recover time. The procedure is performed under anaesthesia, the type of which is determined during consultation with the anaesthesiologist. Usually, spinal anaesthesia is used.