20% of Houstonians with symptomatic hemorrhoids have an associated anal fissure. The co-existence of both disorders is not surprising. Both anal fissures and hemorrhoids (Almorranas in Spanish) are caused by constipation and diet poor in fiber. Both diseases cause significant discomfort leading to decreased quality of life.
Hemorrhoids are dilated blood vessels of the lower rectum. An anal fissure is a tear of the thin moist lining of the anus. Both anal fissures and hemorrhoids are associated with increased anal sphincter muscle tone. Nitroglycerine ointment is commonly prescribed to relax anal sphincter muscle and alleviate symptoms. Anal fissure symptoms include pain and bleeding especially after a bowel movement.
A physician makes a diagnosis of anal fissure by visual inspection. Most anal fissures are located in the posterior midline. Anal fissures associated with crohn’s disease, leukemia and HIV are typically off the midline.
Anal fissure treatment starts with lifestyle changes including increased fiber in diet, use of laxatives and avoid straining. At Houston hemorrhoid clinic, we recommend increasing laxative and fiber use up until getting very loose stools (consistency of yogurt) to minimize anal fissure irritation with bowel movements. We add nitroglycerin ointment to be applied to anal sphincter to relax the muscle and promote fissure healing. In some cases, we prescribe cortisol ointments to reduce inflammation. Anal sphincterotomy is reserved for anal fissures that don’t heal. A small cut is made in the internal sphincter to relax the muscle and allow fissure healing.