8. Anal fissure


The anal fissure is a longitudinal tear/crack of the anal skin. It usually is at about 6 o'clock position (posterior) and develops mainly due to overstretching or irritation of the anal skin. It usually occurs from the inside out radialy. The tear begins at the outside anal skin and ends usually at the boundary line between anal channel and final intestine, the Linea Dentata. In chronic cases, there often is an enlarged anal papilla (knot) which prevents the fissure from healing up. Outside often develops a skin tag, which has no disease value except interfering the hygiene.


Because of the tear, the internal sphincter (closing) muscle get tensed up. This limits the blood supply to the tissue which prevents the healing. A vicious circle develops; the tear favors the muscle spasm which impairs the healing, whereby the tear continues to maintain the spasm. So, it can exist for many years, in those consequences the fissure becomes chronic. By the increased muscle tension, favorable conditions for the emergence of hemorrhoids are also created.

In contrast to the acute fissure where the tear is fresh, the chronic fissure leads to a scarring of the wound which usually is corrected only by surgical removal of the scar tissue.



   - Hard stool
   - Inflammation of the rectum and colon
   - Prolonged diarrhea
   - Injuries of the anal skin  
- Accompaigning to hemorrhoids

Due to the high concentration of nerves, the anal skin is highly sensitive. Because of this fact, anal fissures are very painful. Especially at the beginning of the defecation, the pain is intense. Additionally, minor bleeding, itching and burning can be felt.

The therapeutic principle is based on the healing of the wound by reducing the increased muscle tonus. Therefore relaxing ointments, which content calcium blokkers or nitroglycerin, anal dilatators or Botox injections are used. İn case of insufficient treatment or chronic fissures healing can only be achieved through  surgical operation. Complications such as abscesses or fistulas can occur in untreated cases.

In our clinic  the fissure is totally cleaned up by use of a diod laser  included inflammated tissue and the skin tag (Laser fissurectomy). The high tensed internal sphincter muscle will be digitally relaxated (Sphincterolysis). Due to this procedure a leak of the anus, which is prevalent in conventional surgery much more frequently, occurs very rarely. After surgery, warm sitz baths are performed and  the region should be  showered. Intake of drugs and ointment application has to be done for a short time.

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Anal diseases - still a topic with taboo   |   Anatomy of the final intestine   |   What are Hemorrhoids actually?   |   How does the illness of the hemorrhoids developed?  
 How does the hemorrhoidal illness express itself?   |  
How Hemorrhoids are treated?   |   How is the treatment in the Proktoklinik?   |   Anal fistula / Anal abscess   |   Anal thrombosis   |   Illness of the Linea Dentata   |   Skin folds (Mariscs)   |   Condyloms

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