What are fissures and how are they treated?
Fissures are tears in the lining of the anus. They may be superficial or deep. Fissures are especially common in Crohn’s disease. They differ from fistulas in that fissures are confined to the anus and do not connect to other parts of the bowel, other internal organs, or the skin. Still, fissures can cause mild to severe rectal pain and bleeding, especially with bowel movements. The most common treatment for anal fissures is periodic sitz baths or topical creams that relax the muscle (sphincter) around the anus. Injections of tiny amounts of botulinum toxin into the muscles around the anus have been reported to be helpful in relaxing the sphincter, thereby allowing the fissures to heal. The benefit of this type of therapy, however, is still controversial. Sometimes, surgery is needed to relieve the persistent pain or bleeding of an anal fissure. For example, the surgeon may cut out (excise) the fissure. Alternatively, the muscle around the anus can be cut (sphincterotomy) to relax the
