Anal Fissure

An anal fissure is a non-healing chronic tear in the lining of the anal canal that usually extends to the edge of the anus. An anal fissure is usually located within the anal canal and as such, is not palpable with the finger.

The two commonest symptoms are that of severe anal pain and fresh blood when passing motion.

The pain and blood occur when the stools abrade and stretch out the anal fissure during the passage of the motion.

Some patients may feel a small skin tag (an extra bit of skin) at the edge of the anus. This is known as a Sentinel Skin Tag and usually occurs together with an anal fissure. The skin tag itself is not tender. The skin tag can be removed during the surgery for the anal fissure.

Most individuals with an Anal Fissure usually report an episode of passing hard stools that preceded the development of symptoms. It is postulated that the passage of hard stools may have caused an acute tear that subsequently develops into a chronic non-healing anal fissure.

The development of anal fissures usually occurs in a subset of susceptible patients, namely those with high resting anal muscle tone. This is however not a conscious nor voluntary action on the part of the individual. As a result of the high resting anal pressure, the anus will get overly stretched out during the passing of motion and hence leading to an acute tear. Due to a decreased blood supply from the high resting anal pressure, the tear does not heal and ends up as a chronic non-healing tear.