An anal fissure fissure-in-ano is a small, oval shaped tear in skin that lines the opening of the anus. Fissures typically cause severe pain and bleeding with bowel movements. Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids. Anal fissures can occur at any age and have equal gender distribution. A small number of patients may actually have fissures in both the front and the back locations. Fissures located elsewhere off to the side should raise suspicion for other diseases see below and will need to be examined further.
Symptomatic hemorrhoids come from inflammation of the mucosa and interstitial tissue surrounding the normal veins of the anorectum. These veins provide the normal pathway for return of blood from the anus and rectum back through the circulation to the heart. Of importance is the fact that the veins in the rectum drain into the portal circulation and thus to the liver prior to returning to the heart, while the veins of the anus drain directly into the central circulation. I am frequently asked questions by patients about internal versus external hemorrhoids. The distinction is somewhat artificial as external hemorrhoids are merely the external component of a hemorrhoid that originates internally. The dividing line between external and internal is called the dentate line, which is the point at which rectal mucosa changes to anal skin.
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Back to Anal fistula. There are several different procedures. In many cases, it's not necessary to stay in hospital overnight afterwards. The most common type of surgery for anal fistulas is a fistulotomy. In cases where the risk of incontinence is considered too high, another procedure may be recommended instead.