Anal Fissure Specialist In Bozeman, Montana

What is an anal fissure?

An anal fissure is a tear in the thin, sensitive skin of the anal canal. Most fissures develop in the midline, either at the back or front of the anus.

The tear exposes the underlying internal sphincter muscle, producing sharp pain and muscle spasm. The spasm reduces blood flow to the injured tissue, which can prevent healing and create an unending cycle of pain, spasm, and repeated tearing.

A recent fissure may heal with conservative treatment. A chronic fissure has usually been present for more than six weeks and may develop thickened edges, exposed sphincter fibers, or an external skin tag known as a sentinel tag.

What causes an anal fissure?

Most anal fissures result from trauma to the anal canal during a bowel movement. Common causes include:

Constipation and hard stools

Large, hard, or dry stools can overstretch and tear the anal lining. Straining and repeatedly passing difficult stools can prevent the fissure from healing.

Childbirth and other local trauma

Childbirth, anal intercourse, instrumentation, or other trauma may produce an anal fissure.

Underlying disease

Fissures located away from the usual midline position, multiple fissures, or fissures with an unusual appearance may be associated with Crohn’s disease, infection, immune suppression, or anal cancer. These fissures require careful specialist evaluation and treatment of the underlying condition.

What symptoms does an anal fissure cause?

The classic symptom is sharp or tearing pain during a bowel movement. The pain may continue as burning, throbbing, or spasm for minutes or hours afterward.

Other symptoms may include:

• Bright-red blood on toilet tissue or the surface of the stool
• Fear or avoidance of bowel movements because of pain
• Anal burning or itching
• A visible tear
• A small external skin tag near a chronic fissure
• Sphincter spasm or difficulty relaxing during a bowel movement

Foul-smelling drainage, fever, marked swelling, or constant worsening pain is less typical of a simple fissure and may indicate an abscess, fistula, or another condition.

How is an anal fissure diagnosed?

The colorectal team can often diagnose an anal fissure from the symptoms and a careful external examination. Because the area may be extremely tender, the evaluation is performed gently, and a painful internal examination is not always necessary at the first visit.

The team also determines whether the fissure has a typical appearance or whether additional evaluation is needed to exclude inflammatory bowel disease, infection, malignancy, or another anorectal disorder.

How are anal fissures treated?

Treatment is designed to soften bowel movements, prevent repeated trauma, relax the internal sphincter, restore blood flow, and allow the fissure to heal.

Conservative treatment

Initial treatment commonly includes fiber, adequate hydration, stool-softening medication when needed, warm sitz baths, and avoidance of straining. A topical anesthetic may provide temporary pain relief.

Prescription topical medication

Topical calcium-channel blockers such as diltiazem or nifedipine relax the internal sphincter and improve blood flow to the fissure. These medications allow many chronic fissures to heal without surgery.

Botox injections

Botox is injected into the internal anal sphincter to temporarily reduce spasm and pressure. This improves blood flow and gives the fissure time to heal without permanently dividing the muscle.

Dr. Zehnpfennig performs Botox treatment for patients whose fissures do not resolve with bowel-habit changes and topical therapy, as well as selected patients for whom sphincter-preserving treatment is especially important.

Lateral internal sphincterotomy

Lateral internal sphincterotomy is the most effective definitive treatment for a typical chronic anal fissure. Through a small incision, Dr. Zehnpfennig precisely divides a limited portion of the internal sphincter muscle. This relieves the pathologic spasm, restores blood flow, and allows the fissure to heal.

The operation is performed with careful patient selection and precise technique to maximize healing while protecting bowel control.

When should I see a colorectal specialist?

Schedule an evaluation if:

• Pain or bleeding persists despite improved bowel habits
• Symptoms have lasted more than several weeks
• Pain is severe or occurs after nearly every bowel movement
• The fissure repeatedly heals and returns
• You have a fissure away from the midline or more than one fissure
• You have Crohn’s disease, immune suppression, or another relevant medical condition
• You are unsure whether the symptoms are caused by a fissure, hemorrhoid, abscess, fistula, or another disorder

Anal fissures are common and highly treatable. Our colorectal team provides discreet evaluation, medical management, office-based treatment, and advanced surgical care when needed. Call the office or request an appointment online for expert diagnosis and lasting relief.