Anal fissure treatment at OpenMed Warsaw
An anal fissure is a small tear in the lining of the anal canal. The typical symptom is sharp pain during a bowel movement, which can persist for tens of minutes or longer afterwards. Sometimes a small amount of bright red blood also appears on the toilet paper or on the surface of the stool.
At OpenMed in Warsaw you can book a proctology consultation, during which the doctor assesses the cause of your symptoms and proposes appropriate treatment. Many anal fissures can be treated effectively without surgery, especially if treatment is started at an early stage.
How to recognise an anal fissure?
Symptoms often begin after passing a hard stool or after a period of constipation. The damage to the lining causes pain, and the pain can lead to a reflex increase in the tone of the anal sphincter. This makes healing harder and causes the wound to reopen during subsequent bowel movements.
It is worth seeing a proctologist if you experience:
- severe, burning or stabbing pain when passing stool,
- pain that persists after a bowel movement,
- minor bleeding from the anus,
- recurrent constipation and pain that makes you avoid going to the toilet,
- a fissure that will not heal despite treatment so far,
- a return of symptoms after a period of improvement.
Similar symptoms can occur in other diseases of the anus and rectum. This is why recurring pain or bleeding should not be attributed to haemorrhoids or a fissure without an examination first.
Proctology specialists at OpenMed
Book a proctology consultation for anal and rectal symptoms, diagnosis, and treatment planning.
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What does a proctology consultation involve?
The visit starts with a conversation about your symptoms. The doctor asks, among other things, about how long the pain has lasted, bleeding, bowel habits, constipation, stool consistency and any previous treatment.
The doctor then examines the anal area. A typically located fissure can often be recognised from the symptoms and an examination of this area alone. The extent of any further examination is adjusted to the patient's situation. If the pain is severe, the doctor may limit any steps that could make it worse.
If the lesion looks unusual, if there are several fissures or if they are in an atypical location, additional diagnostics may be needed. Such lesions can accompany, among other things, inflammatory bowel disease or certain infections.
How is an anal fissure treated?
The first goal of treatment is to break the mechanism that prevents healing. A fissure will not heal well if every bowel movement causes a fresh injury.
The basis of management is therefore achieving regular, soft stools. The doctor may recommend changing the amount of fibre and fluids in your diet and, if needed, suitable preparations that make bowel movements easier. Warm sitz baths can also help, as they reduce discomfort and tension in the anal area.
Depending on the nature of the fissure, the doctor may add topical treatment. The preparations used are intended to reduce the tone of the internal sphincter and create better conditions for the damaged lining to heal.
The treatment method should be chosen after an examination. Trying one "haemorrhoid" ointment after another on your own may bring no improvement if the real cause of the pain is an anal fissure.
Acute and chronic fissure - what does this mean for treatment?
A fresh fissure has a better chance of healing with conservative treatment and improved bowel habits. If the lesion persists for a long time, its edges can become remodelled and a chronic fissure develops.
In that case, regulating the stool alone may not be enough. The doctor then assesses whether further treatment to reduce sphincter tone is needed, or whether the patient should be considered for a different approach.
One option used in selected patients is an injection of botulinum toxin into the sphincter. In chronic fissures that do not respond to conservative treatment, surgery is also considered, most often a partial division of the internal sphincter. The decision requires an individual assessment, because sphincter function and the risk of problems with bowel control, among other things, have to be taken into account before the procedure.
How to stop a fissure from coming back?
Healing the wound itself does not always solve the problem if constipation and hard stools continue. That is why an important part of treatment is maintaining a stool consistency that does not injure the anal canal again.
You should also avoid holding in the urge to go for long periods and avoid straining excessively. If constipation persists despite changes to your daily habits, the doctor may suggest further steps.
A fissure can also appear with frequent loose stools or diarrhoea. In that case, treatment should also include finding the cause of the bowel disturbance.
When does anal bleeding need further diagnostics?
Bright red blood can accompany a fissure, but not every case of anal bleeding is caused by one. If the bleeding recurs, your bowel habits have changed or the doctor finds other worrying features, further diagnostics may be recommended.
Depending on the situation, a proctological examination, rectoscopy or colonoscopy may be needed. The scope of the tests is matched to your age, symptoms, family history and the findings of the medical examination.
Anal fissure treatment - FAQ
Yes. Fresh fissures in particular are often treated conservatively. What matters is regulating stool consistency and, if indicated, using appropriate topical treatment.
No. A fissure is a tear in the lining of the anal canal, whereas haemorrhoids are normal vascular structures that can become enlarged and cause symptoms. Both problems can cause bleeding, which is why the diagnosis is best confirmed during an examination.
The area of the anal canal is richly supplied with nerves. In addition, the injury can trigger a spasm of the internal sphincter, which increases the pain and makes healing harder.
Not for every patient. The doctor may recommend one if the symptoms or other factors call for an assessment of the further sections of the large bowel. A typical fissure on its own does not automatically mean a colonoscopy is necessary.
It is considered mainly for chronic fissures that do not heal despite properly conducted conservative treatment. The choice of method depends on the appearance of the lesion, the treatment given so far and the patient's individual risk.