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Table of Contents
Understanding Anal Fissure
Anal fissures are small tears in the lining of the anal canal. They tend to form due to the stretching and tearing of the lining of the anus, which can occur due to the passing of large, hard stools or severe bouts of diarrhoea. Anal fissures often cause pain and bleeding with bowel movements. Specialists in Singapore employ various methods for anal fissure treatment, aiming to reduce discomfort and promote healing without surgical intervention.
Anal fissures are very common in Singapore and can affect people of any age. Usually, they only require simple treatments such as topical ointments or increased fibre intake. Only in severe or chronic conditions will anal fissure surgery be recommended by your doctor. For those unsure about their condition, our detailed comparison of anal fissures versus haemorrhoids provides clear insights
Causes Of Anal Fissures
Anal fissures are caused by trauma to the lining of the anus from a bowel movement or other stretching of the anal canal. This can be due to a hard, dry bowel movement or loose, frequent bowel movements. Patients with a tight anal sphincter muscle are more likely to tear and bleed when passing stools, developing anal fissures. Less common causes of fissures include inflammatory bowel disease.
Symptoms Of Anal Fissures
Anal fissures typically cause a sharp pain that starts with the passage of stool. This pain may last several minutes to a few hours. As a result, many patients may try not to have bowel movements to prevent pain.
Other symptoms include:
- Bright red blood on the stool or toilet paper after a bowel movement
- A small lump or skin tag on the skin near the anal fissure (often mistaken as a haemorrhoid)
Most acute anal fissures can heal on their own with proper self-care and lifestyle adjustments. However, the healing process can vary for everyone and would depend on the severity of the fissure. Anal fissures that do not resolve within 6 to 8 weeks are considered chronic, necessitating treatment.
Anal fissures can sometimes be misdiagnosed as haemorrhoids because both conditions cause bleeding and pain. However, the overriding symptom for anal fissures is severe pain with some bleeding, whereas the overriding symptom for haemorrhoids is a lump at the anus with bleeding usually without much pain. A thorough examination by an experienced doctor will usually be able to differentiate one condition from another.
Anal Fissures Treatment
Patients with chronic anal fissures often find themselves in a vicious cycle where a recurring anal tear causes prolonged anal pain, leading to persistent anal spasms and increased anal muscle tone. This, in turn, results in chronic constipation, producing large, hard stools during defecation, which further exacerbates the recurring anal tear. Anal fissure treatment in Singapore often involves a combination of medical therapies and lifestyle adjustments to effectively manage symptoms.
In Singapore, chronic anal fissures are treated with medication and this has an 80% to 90% chance of successful treatment. The aim of medical treatment is to heal the anal tissues and break the pain cycle. Pain is treated with painkillers, anal spasms are treated with Rectogesic ointment, and constipation is managed with laxatives. The tear will usually heal with such treatments. Failure to recover despite medical treatment is an indication for anal fissure surgery (10% to 20%). Chronic anal fissure treatment primarily focuses on alleviating pain and facilitating healing, often involving a combination of medication, lifestyle adjustments, and sometimes surgical options.
Anal Fissures Surgery Treatment
Although most anal fissures do not require surgery, chronic fissures may be harder to treat and surgery becomes the best option. Surgical division of the inner part of the anal sphincter (lateral internal sphincterotomy) is the gold standard treatment for chronic anal fissures. The aim of surgery is to help the anal sphincter muscle relax which reduces pain and spasms, allowing the fissure to heal. This is usually done as a day surgery procedure.
Alternatives To Surgery
Botulinum toxin (Botox®) injection into the anal sphincter causes temporary muscle weakness to the internal sphincter and hence relaxes the muscle tone. As this is temporary, it can be repeated though its effectiveness is reduced with each repeated dose.
Learn more about the range of treatments available for anal fissures, including both surgical and non-surgical options.
Treatment Prognosis
Most patients can return to work and go back to daily activities a few days after anal fissure surgery. Complete healing from anal fissure after both medical and surgical treatments take 6 to 8 weeks. It is important for patients to discuss all available options for chronic anal fissure treatment in Singapore to determine the most appropriate course of action based on their specific condition.
Even when the pain and bleeding lessen, it is important to maintain good bowel habits and eat a high-fibre diet. For those dealing with chronic anal fissures, incorporating dietary changes such as increasing fibre intake can play a crucial role in treatment by easing bowel movements and reducing strain. Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing. Anal fissures may recur. A fully healed fissure can reappear after a hard bowel movement or trauma.
Here are our observations of anal fissure treatments in Singapore:
- Botox® injections are associated with healing of chronic anal fissures in 50% of patients.
- Sphincterotomy is successful in more than 90% of patients. Less than 1% of patients have a risk of faecal incontinence.
Anal fissures do not increase the risk of colon cancer nor cause it. However, more serious conditions can cause similar symptoms. Even when a fissure has healed completely, your surgeon may request other tests. Discover how a colonoscopy in Singapore can help diagnose underlying causes of symptoms like anal fissures, rectal bleeding and other colorectal conditions.
How We Can Help With Hemorrhoids (Piles Surgery In Singapore)
Dr QM Leong is an experienced colorectal doctor with relevant medical specialities in fields such as colorectal cancer and piles treatment in Singapore, who will accurately diagnose your condition for any signs of hemorrhoids before determining the right treatment for your condition.
We are fully committed to providing a pleasant experience, treatment and patient care, so do not hesitate to call to find out about piles surgery in Singapore or make an appointment with us to understand more about hemorrhoids.
Frequently Asked Questions
What Are The Standard Treatments For Anal Fissures?
Standard treatments in Singapore for anal fissures include topical ointments containing nitroglycerin or calcium channel blockers to relax the anal sphincter. Changing your diet by increasing fibre intake and drinking more water can help soften stools.
Medications like painkillers and stool softeners manage pain and prevent constipation. Sitz baths, warm baths to relax the anal muscles, are also commonly recommended.
How Does Treatment For Chronic Anal Fissures Differ From Acute Fissures?
In Singapore, treatment for chronic anal fissures may involve more intensive measures compared to acute fissures. Other measures can include Botox injections to relax the anal sphincter muscles or surgical procedures like lateral internal sphincterotomy to relieve pressure on the fissure.
Long-term use of medications, both topical and oral, may also be prescribed to control pain and promote healing.
How Do I Prepare For Anal Fissure Surgery?
Preparing for anal fissure surgery typically involves consulting with your surgeon in Singapore to discuss the procedure, its risks, and benefits. A medical evaluation ensures you are in good health for surgery.
You will need to follow pre-operative instructions provided by your healthcare team, which may include fasting before anal fissure surgery and discontinuing certain medications as advised.
Does The Cost Of Anal Fissure Surgery Include Post-Operative Care?
The cost of anal fissure surgery in Singapore may or may not include post-operative care. It’s essential to clarify this with your healthcare provider or surgeon before the procedure to understand what expenses are covered. Understand the colonoscopy cost in Singapore by visiting our comprehensive guide that outlines various price ranges and factors influencing them.
What Should I Consider When Evaluating The Cost Of Anal Fissure Surgery?
When evaluating the cost of anal fissure surgery in Singapore, consider all potential expenses involved. Other expenses include hospital fees covering the surgical facility, anaesthesia, and the surgeon’s professional fees.
Additionally, inquire about the coverage of post-operative care, such as follow-up visits, medications, or management of complications. Check with your insurance provider to know what portion of the procedure may be covered under your policy.
What Should I Do If My Anal Fissure Starts Bleeding?
If your anal fissure starts bleeding, take immediate steps to manage it. Gently apply pressure with clean gauze to the area to stop the bleeding. Avoid straining during bowel movements and take steps to prevent constipation.
If bleeding persists or if you experience excessive bleeding, seek medical advice promptly from your healthcare provider in Singapore.
What Are The Risks Associated With Bleeding Anal Fissures?
Bleeding anal fissures can pose several risks, including anaemia due to chronic blood loss. There is also a risk of infection, especially if the area becomes irritated or contaminated.
Persistent bleeding may indicate that the fissure is not healing properly, potentially leading to chronic issues or complications. Monitoring anal fissure bleeding closely and consulting a healthcare professional in Singapore for appropriate evaluation and management is essential.
About Dr QM Leong
Colorectal & Hernia Surgeon in Singapore
Dr Leong is a general and colorectal surgeon in Singapore who graduated from the University of London in 2000. He obtained his membership to the Royal College of Surgeons of Edinburgh in 2003 and started working in Tan Tock Seng Hospital in 2003. He started his Advanced Specialist Training in 2005 and passed his fellowship exams in 2008. Dr Leong was awarded the prestigious MOH HMDP scholarship to train under Prof Kim Seon Hahn in Korea University for Laparoscopic and Robotic colorectal surgery in 2010.
Dr Leong is amongst a handful of hernia and colorectal surgeons in Singapore who practice Single Incision Laparoscopic surgery. This is a technical and complex procedure that is minimally invasive, speeds up recovery, and confers excellent cosmetic results. Dr Leong also routinely trains basic and advanced specialist trainees in laparoscopic surgery, and regularly proctors consultant surgeons in complex colorectal cases.
Beyond laparoscopic surgery, Dr Leong also performs a repertoire of minimally invasive General Surgery procedures. He is also an experienced endoscopist with more than 10000 procedures, performing diagnostic and therapeutic scopes for elective and emergency surgical conditions. He performs direct access colonoscopies and oesophago-gastro-duodenoscopy for patients and will strive to perform the procedures on the same day if possible for patients’ convenience.
About Dr QM Leong
Colorectal & Hernia Surgeon in Singapore
Dr Leong is a general and colorectal surgeon in Singapore who graduated from the University of London in 2000. He obtained his membership to the Royal College of Surgeons of Edinburgh in 2003 and started working in Tan Tock Seng Hospital in 2003. He started his Advanced Specialist Training in 2005 and passed his fellowship exams in 2008. Dr Leong was awarded the prestigious MOH HMDP scholarship to train under Prof Kim Seon Hahn in Korea University for Laparoscopic and Robotic colorectal surgery in 2010.
Dr Leong is amongst a handful of hernia and colorectal surgeons in Singapore who practice Single Incision Laparoscopic surgery. This is a technical and complex procedure that is minimally invasive, speeds up recovery, and confers excellent cosmetic results. Dr Leong also routinely trains basic and advanced specialist trainees in laparoscopic surgery, and regularly proctors consultant surgeons in complex colorectal cases.
Beyond laparoscopic surgery, Dr Leong also performs a repertoire of minimally invasive General Surgery procedures. He is also an experienced endoscopist with more than 10000 procedures, performing diagnostic and therapeutic scopes for elective and emergency surgical conditions. He performs direct access colonoscopies and oesophago-gastro-duodenoscopy for patients and will strive to perform the procedures on the same day if possible for patients’ convenience.
Insurance
Our surgery is on the panel of most of the major insurance companies and if you are covered by corporate insurance, you may be entitled to a cashless visit to our clinic.
Get In Touch
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