Most people initially become aware they have a tear in the skin around their anus because of the stinging and burning that occurs when they use the bathroom. These tears are known as anal fissures. In addition to the pain, sufferers may also notice a small amount of bleeding while using the bathroom. If this happens to you, you may be aware of when the tear occurs, especially if it is caused by straining during constipation or passing an especially hard stool.

Pregnant women and patients who have digestive disorders are at a higher risk of anal fissures than the general population, but they can affect almost anyone. Children may develop them due to a stomach virus with loose stools, or a diet that leads to constipation.

How Do Anal Fissures Become A Chronic Issue?

For the majority of sufferers, an anal fissure is a minor annoyance that will heal on its own without any additional treatment from your doctor. These occurrences are known as acute cases, and probably happen to almost everyone at some point. If you’ve just experienced symptoms for the first time, there is no reason to panic. There is a high probability that it will heal within a week to ten days.

When an acute fissure does not heal quickly or recurs frequently, the tear turns into a chronic condition. This diagnosis may be made by a general practitioner or a proctologist after about six weeks of symptoms from the tear. If treatment is not applied, chronic anal fissures could exist and continue to be symptomatic for a year or even longer.

For some sufferers, the issue may lie in the fact that the cause of the tear has not be resolved. For example, if constipation is a frequent problem, you may need to increase your fiber intake or use a stool softener regularly. The best option is to discuss how to manage your bowel issues with your colorectal surgeon in Los Angeles.

Although fissure symptoms typically disappear within an hour or two after using the bathroom, this type of chronic issue can cause a lot of pain in the meantime. If the tear has not healed by the six-week mark, or has healed and then occurred again, a visit to your doctor is the most effective method to ensure there is not a more serious problem and you find relief quickly.

How Will The Doctor Treat A Chronic Anal Fissure?

Initially, your doctor will most likely put you on a non-invasive regimen aimed at easing bowel movements. This should give the fissure time to heal before more invasive therapies must be used. You will probably be put on a diet high in fruits, vegetables, and whole grains. These high-fiber foods bulk stools and make them easier to pass. Drinking adequate amounts of liquids will also help with elimination. Because the problem may be exacerbated by tension and spasms in your internal anal sphincter, the doctor may want you to take sitz baths. Sitting in a shallow tub of warm water for 10 to 15 minutes can relax this muscle and offer faster healing.

If these very conservative fissure treatments are not effective within a few days, you can discuss medications with your physician. Depending on the doctor’s preference and the details of your case, a topical ointment may be prescribed. You will apply this cream to the area several times a day. According to Pharmacy Times, the medications used may include a hydrocortisone steroid treatment, lidocaine pain relieving gels, calcium channel blockers, which relax the muscle, or nitroglycerin. Most commonly used for patients with chest pains, nitroglycerin  is used in smaller concentrations to reduce the pressure on the anus and aid speedy healing. Calcium channel blocking drugs, CCBs, can also be prescribed for this type of treatment. Applied twice daily, these drugs can relax the sphincter muscles to allow healing. This is sometimes called a pharmacologic sphincterotomy.

Is Surgery Necessary?

If the pharmacologic efforts do not stop the spasms and release tension enough to allow the fissure to heal completely, a more invasive approach may be called for. The procedure that is most commonly used is called a lateral internal sphincterotomy. During the surgery, a colon and rectal surgeon will use a scalpel to cut through a very small amount of the internal anal sphincter, forcing it to relax and preventing further spasms from fissure-related pain.

This outpatient surgery may sound like it is creating more of a problem, but it is highly effective as a cure for chronic tears in the anal lining. The incision may be painful, but many patients experience immediate relief from the pain of both the anal fissure and the muscle spasms it caused. This may mean a drastic reduction in suffering, even on the same day as the procedure is performed.

The recovery necessary after a lateral internal sphincterotomy is short, especially when compared to the months or years that patients sometimes deal with severe pain from fissures. Some activities may be limited for up to six weeks, although most patients can return to the majority of their favorite past times within the first two weeks. Most also miss less than five days of work. Full healing requires four to eight weeks.

Next, read Lateral Internal Sphincterotomy: The Recovery