An anal fissure is a tear in the skin near the anus. What causes it, and what solutions exist?

Important: this article is provided for information purposes only and does not replace professional medical advice. The information presented here is based on scientific studies and medical recommendations, but does not constitute a prescription or personalized diagnosis. If you are suffering from symptoms of anal fissure or any other condition, consult a qualified healthcare professional for an assessment and treatment tailored to your situation.

Anal fissures: is it serious?

An anal fissure is generally not serious: it's simply a tear in the skin around the anal canal. It can, however, be a handicap in everyday life, causing pain, difficulty in going to the toilet and disturbed sleep.

Pain can also cause other symptoms, such as reflex constipation.

How to treat anal fissures

Topical creams

Different types of creams may be relevant in the case of anal fissures:

• Anaesthetic creams : often based on Lidocaine, to reduce pain. However, research show that lidocaine alone has a limited effect on healing.
• Topical calcium channel blockers : These drugs, originally used orally to treat hypertension, also have a muscle-relaxing effect. In cream form, they reduce the tone of the internal anal sphincter and promote better blood circulation in the fissured area. Studies have shown that certain vasodilators such as Diltiazem offered good therapeutic results.
• Healing creams: as their name suggests, they help the wound to heal.
• Anti-inflammatory creams: to reduce irritation

Beyond their soothing effect, these creams can act on the underlying causes by relaxing the sphincter. This allows bowel movements to pass more smoothly, helping to speed healing.

In practice, almost half of all anal fissures are resolved by the use of topical treatments such as calcium channel blockers.

Food supplements & nutrition

A change of diet may also be essential in the context of anal fissures:

• Dietary fiber: there's an abundance of literature indicating that fiber can have a beneficial effect on anal fissures by thinning the stool. These can be ingested in the form of dietary supplements such as psyllium, or by adjusting the diet (nuts, fruit, vegetables, wholemeal bread/rice, etc.).
• Pro-biotics : probiotics can have a similar effect to fiber in facilitating digestion, transit and stool output, and therefore also help relieve pressure on the rectal wall
• Better hydration: good hydration can also help to improve transit, reducing pressure on the anal wall and helping to heal anal fissures.

It should be noted that there are other "gentle" methods that research suggests are effective against anal fissures. For example, one study shows that perineal re-education (Kegel muscles) reduces the risk of anal fissure recurrence (in the study, 55.7% of patients who underwent perineal re-education exercises healed, compared with only 21.4% in the control group).

Surgery

Surgery is considered the most radical and effective treatment for refractory chronic anal fissures.

The gold-standard procedure is the internal lateral sphincterotomy, which involves incising part of the internal anal sphincter (usually on the side opposite the fissure). By releasing the tension in the muscle, the cause of the pain is eliminated, allowing the fissure to heal in over 90% of cases within a few weeks.

The importance of consulting a doctor

As mentioned in the introduction, if you suffer from anal fissures, consult a healthcare professional. Your doctor or pharmacist will be able to advise you on the best solution for your specific case. Although consultations for anal fissures may seem inconvenient, it's important to bear in mind that doctors are used to treating these cases.