Anal fissure is associated with various signs and symptoms. These include pain and bleeding during bowel movement, itchiness in the anorectal region, difficulty in urination, and passage of malodorous discharge due to the presence of pus. An immediate consultation is needed if such symptoms arise. A person with anal fissure can be referred to a gastroenterologist or a colorectal surgeon.
A gastroenterologist is a doctor who specializes in the treatment and management of gastrointestinal tract and liver diseases. They have unique training and experiences in the medical management of bowel conditions. Anal fissures are located in the anorectal region. It is the conjunction between the anus and the rectum. The anorectal region is part of the gastrointestinal tract. It is, therefore, a good option to ask for consultation from a gastroenterologist. A gastroenterologist can provide good medical treatment for the management of acute anal fissures. These are fissures that are showing symptoms for less than six months. Acute anal fissures can be addressed by simple medical treatments and may not require surgery.
A gastroenterologist usually starts treatment by evaluating the patient’s medical history and conducting a physical examination of the anorectal region. The buttocks are separated to clearly view the anorectal region and is inspected for the presence of anal tears. If no tear is found, a more thorough inspection may be needed. The gastroenterologist will apply a topical anesthesia to the anus and the anal canal. A cotton applicator is then inserted to the anus to locate the source of the pain. A gastroenterologist may be able to tell the patient if the anal fissure is chronic or acute through physical examination.
A linear tear is a clear indication of an acute anal fissure. Chronic anal fissures are associated with the presence of a skin tag known as sentinel pile, visible muscles of the anal sphincter at the base of the fissure, and an enlarged anal papilla. If the anal tear comes with bleeding episodes, a more invasive diagnostic procedure is performed. Sigmoidoscopy is performed on patients who are under 50 years old and have typical anal tears. This involves the insertion of a flexible viewing tube in the anus. This will help the gastroenterologist to view the distal end of the colon.
For patients who have a history of colon cancer and are older than 50 years of age, a colonoscopy is usually performed. This involves visualization of the whole colon. Both procedures are used to exclude the other possible causes of rectal bleeding.
For people with chronic anal fissures, a colorectal surgeon is the best type of doctor to have a consultation with. Chronic anal fissures are anal tears that are recurrent and are present for more than six months. This type of fissure is best treated by colorectal surgeons. Chronic anal fissures that are not treated by conservative medical measures can be addressed by surgical treatment. Colorectal surgeons are experts in the surgical treatment of the anus, rectum, and colon. They may treat recurrent fissures through lateral internal sphincterectomy, fissurectomy, and anal advancement flap coverage. These are surgical procedures that can completely remove the fissure.
Both colorectal surgeons and gastroenterologists can treat anal fissure. Acute anal fissures are usually treated by a gastroenterologist, while chronic anal fissures are best addressed by a colorectal surgeon. A gastroenterologist may also refer a person to a colorectal surgeon if he thinks that more invasive treatments are needed for the patient’s bowel condition.
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