They are tears that occur in the anal canal and extend to the outer skin layer, involving the mucous membrane of the anus. They mostly occur during hard straining and in the area from the mucocutaneous junction to the dentate line.

Due to the pain that occurs after the fissure occurs, defecation becomes more difficult with the reflex contraction of the muscles around the anus and this prevents the healing of the fissure. As defecation is delayed for fear of pain, the stool becomes harder and the fissure deepens.

Nipples may appear around the anal canal as a result of thickening of the surrounding skin.

 

Although anal fissure can be seen at any age, it is more common in young and middle-aged adults. It is seen with equal frequency in men and women, there is no gender discrimination.

 

Anal fissures are defined in two ways as acute and chronic. There is no difference between acute and chronic fissures in terms of findings. Fissures that do not heal within 15-20 days, the wound edges have become fibrotic and the base is ulcerated are considered chronic fissures.

The location of anal fissures in the anal canal is at 12 o'clock (toward the coccyx) in 99% of men, and at 6 o'clock (forward) in 1% of men.

On the other hand, 90% of women are at 12 o'clock, and 10% are at 6 o'clock. Anal fissures are rarely located on the side walls. In atypically located fissures, inflammatory diseases of the intestine such as crohn, diseases such as tuberculosis, syphilis, AIDS, anal abscess and anal cancers should be kept in mind in the differential diagnosis.

 

In the treatment of anal fissure, first of all, the patient's nutrition and toilet habits should be regulated, then the fissure should be treated with stool softening drugs, local anesthetic creams or warm sitz baths used for muscle relaxation, and local effective creams.

In patients who do not benefit from these treatments, muscle relaxation should be provided by Botox application or surgery.