These are tears in the lining of the inside of the back passage. They are extremely painful when people have their bowels open, and the classic
description of them is of a “feeling like passing broken glass.” They are common and may be related to periods of constipation, although the cause is
not known with certainty. Often once a fissure appears there is a downward spiral of pain on passing stool followed by reluctance to do so as a result
which then leads to worsening constipation and firmer stool which in turn leads to more pain.

Will I need to be examined in clinic?
The diagnosis is primarily made on the description of the symptoms. As well as the pain, there is also usually bleeding at the time of passing a stool.
People are often concerned about being examined internally in clinic due to the pain, but as long as the history is typical, I will not need to perform
such an examination if it is too sore. I will inspect the back passage for signs of a fissure and if one is visible then an internal examination is often
unnecessary. If a fissure is not seen then I would try a gentle internal examination, but always on the understanding that if it becomes too painful I will
stop immediately.

What is the treatment for an anal fissure?
The initial treatment is usually a combination of laxatives to keep the stools soft to reduce the pain on passing a stool together with a cream which
is good at healing fissures. It works by reducing spasm in the sphincter muscles inside the back passage and a significant proportion of people with
a fissure find it has healed with this combination of treatments within 6 weeks. In some cases it may be necessary to do an examination of the back
passage under general or spinal anaesthetic as a day case procedure. This may be needed if the history is not typical of a fissure but it is not possible to
do a thorough examination in clinic due to the pain. The other reason for doing this is if the cream doesn’t adequately treat the fissure. At the time of
the examination, if a fissure is confirmed then I will inject some botox into the sphincter muscle which is very effective at healing the fissures. Further
treatments are rarely needed, but in the unlikely event the botox fails I will discuss these with you in clinic.

Are there any side effects from the botox?
It is unusual to get any significant side effects. Sometimes people have a little trouble controlling the passage of wind, but leakage of solid or liquid
stool is extremely rare. Regardless, any side effects experienced will wear off when the botox does within 3 months, by which time most fissures
have healed.