What are anal fissures and fistulas?
An anal fissure is a tear in the lining of the anus or the skin around it. An anal fistula is an abnormal passage or channel in the anus that opens into the skin surrounding the anus.
What causes anal fissures and fistulas and who is at risk?
Often no cause for the development of an anal fissure is found. The most commonly associated disorder is constipation.
Anal fistulas are associated with a number of diseases that lead to inflammation of the digestive tract. These include ulcerative colitis and Crohn’s disease (see separate information sheet). More often, however, fistulas are caused by infection and an abscess (pus formation) in one of the glands near the anus. Several anal fissures can also be associated with these conditions.
What are the most common symptoms and complications of anal fissures and fistulas? Sudden, severe pain in or around the anus is a characteristic symptom of an anal fissure. Pain often occurs during or shortly after a hard bowel movement, but can also occur spontaneously.
After that the pain occurs from time to time and is severe, sharp and often in nature; it is often aggravated by bowel movements. As a result, sufferers often avoid opening their intestines, which aggravates constipation and prevents the fissure from healing. The condition is often associated with a so-called “sentinel stack”. This heap or hemorrhoid is a small vein that has fallen from the inside of the anus and is outside. Bleeding may occur from time to time and a streak of bright red blood may be seen on the toilet paper.
The anal fistula is most often associated with an abscess near the anus that causes pain in or around the anus, which can be blunt and throbbing. The abscess releases pus that can be stained with blood and contaminate the underwear. The formation of a fistula leads to an often continuous infiltration of pus or sometimes a finer and watery liquid, which in turn is often covered with blood, from the anus. If the underlying abscess is large enough, it can cause a fever and generally feel uncomfortable.
If a fistula is caused by an inflammatory bowel disease such as ulcerative colitis or Crohn’s disease, other symptoms of the disease may be present. These can be diarrhea, abdominal pain, fever, loss of appetite, weight loss, nausea and vomiting.
What is the treatment for anal fissures and fistulas?
Action plan for self-sufficiency
Avoiding constipation from a high-fiber diet (including lots of fruits and vegetables) helps prevent anal fissures. Such a diet also contributes to the healing process.
If diet alone is not enough to control constipation, a number of medications can be used, many of which are available over the counter from a pharmacist without a prescription. These include liquid lactulose and tablets like senna. Creams or ointments with analgesic local anesthetics are very helpful in relieving pain in anal fissures. Pain relief reduces the spasm of the muscles in the anus, which often prevents the fissure from healing.
If all of the above fail, various operations to treat anal fissures are available. This includes stretching the anus, which is done under general anesthesia (while you are sleeping) and, although usually done as a daily case, may require you to stay in the hospital during the hospitalization night. This procedure leads to a temporary weakening of the muscles around the anus, relieves the spasm and enables healing. Alternatively, a “sphincterotomy” can be performed. This is done under general anesthesia and involves cutting some muscle fibers around the anus. A chronic (long-term) tear that does not respond to the above treatments often needs to be cut and then stitched together.
If an abscess is the cause of an anal fistula, it can only be treated surgically. The operation involves cutting into the abscess and draining the pus. If a fistula is present, it must also be treated surgically. During this operation, the fistula is cut and “opened” to allow healing. This includes a hospital stay.
More rarely, if the fistula is caused by an associated inflammatory bowel disease, the particular disease requires