The Bottom Line on Anal Fissures: From Pain to Relief- A Surgeon's Guide

By Ritha Belizaire, MD FACS FASCRS 

Double Board-Certified General and Colorectal Surgeon 

Owner, Houston Community Surgical 

Is that sharp pain during bowel movements making you dread your daily routine? You might be  dealing with an anal fissure - a small tear that can cause major discomfort. Let's break down what  you need to know about this common but often misunderstood condition. 

What is an Anal Fissure? 

Think of it like a paper cut, but in a much more sensitive area. An anal fissure is a small tear in the  lining of the anal canal that can cause sharp pain during bowel movements and bleeding. Anal  fissures usually occur due to hypertrophic or overly tight anal sphincter muscles causing a  decrease in the blood supply to the skin, resulting in a skin tear. 

Who Gets Them? 

• Young adults (most common) 

• New mothers after childbirth 

• People with chronic constipation 

• Those with inflammatory bowel disease 

• Anyone who regularly strains during bowel movements 

Risk Factors: Why Do They Happen? 

• Chronic constipation or diarrhea 

• Tight pelvic floor muscles 

• Pregnancy and childbirth 

• Heavy lifting 

• Certain medications 

• Foods causing constipation or diarrhea

How Can Pelvic Floor Physical Therapy Help? 

Your pelvic floor physical therapist is a crucial partner in healing anal fissures. They can: • Teach proper toileting mechanics 

• Help relax overly tight pelvic floor muscles 

• Provide biofeedback training 

• Guide you through gentle stretching exercises 

• Teach breathing techniques to reduce strain 

• Offer dietary and lifestyle modifications 

When Should You See a Colorectal Surgeon? 

While most anal fissures heal with conservative treatment, you should consider surgical  consultation if: 

• Pain persists beyond 6-8 weeks 

• Conservative measures aren't providing relief 

• You're experiencing recurrent fissures 

• There's significant bleeding 

• You have underlying conditions requiring evaluation 

Surgical Solutions 

As a colorectal surgeon, I offer several treatment options when conservative measures haven't  provided relief: 

• Compounded ointment used for 4-6 weeks (success rate: 60-75%) 

• Botox injections (success rate: ~80%) 

• Lateral internal sphincterotomy (success rate: >90%) 

• Fissurectomy is performed for chronic fissures during Botox injection or sphincterotomy  

Remember: Early intervention often leads to better outcomes. Don't suffer in silence – start with  pelvic floor physical therapy and know that surgical options are available if needed. 

For more information or to schedule a consultation, contact Houston Community Surgical at 832- 979-5670 or visit www.houstoncommunitysurgical.com.