Anal Fissures and Treatment Options
Dealing with an anal fissure can be a painful and distressing experience. As an FCA-authorised UK broker that has helped arrange over 750,000 policies, WeCovr understands the importance of fast access to diagnosis and treatment. This guide explains anal fissures and how private medical insurance can help you get back on your feet sooner.
WeCovr explains fissures, procedures, and private care pathways
An anal fissure is a common but uncomfortable condition. While many heal on their own, some require medical intervention. Navigating treatment options can be confusing, especially when faced with potential NHS waiting lists.
In this comprehensive guide, we will break down everything you need to know about anal fissures, from the initial symptoms to the various treatment procedures available. We’ll also explore the private care pathway and how a good private health cover policy can provide peace of mind and swift access to specialist care.
What is an Anal Fissure? A Simple Explanation
An anal fissure is a small tear or cut in the delicate skin lining the anus (the opening where stools leave the body). Think of it like a paper cut, but in a very sensitive area. The tear exposes the muscle underneath, leading to sharp pain and sometimes bleeding, particularly during and after a bowel movement.
Fissures can be classified into two types:
- Acute Fissures: These are recent tears that look like a fresh cut. With the right self-care, they often heal within a few weeks.
- Chronic Fissures: A fissure is considered chronic if it lasts for more than six weeks or keeps coming back. These may have a deeper tear and might feature a small lump of skin, known as a 'sentinel pile' or 'skin tag', at the edge of the fissure.
According to NHS data, anal fissures affect around 1 in 10 people at some point in their lives, making them a very common issue. They are most prevalent in young adults but can occur at any age.
Common Causes of Anal Fissures
Anal fissures are typically caused by trauma to the anal canal. The most frequent cause is passing a particularly hard or large stool, which overstretches the lining and causes it to tear.
Other common causes and contributing factors include:
- Constipation: Straining on the toilet due to hard, difficult-to-pass stools is the number one culprit.
- Persistent Diarrhoea: Frequent, loose stools can also irritate and damage the anal lining.
- Childbirth: The pressure on the perineum during labour can sometimes lead to tears.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease can cause inflammation that makes the anal lining more vulnerable to tearing.
- Reduced Blood Flow: Older adults may have reduced blood flow to the area, which can slow healing and make fissures more likely.
- Anal Intercourse: This can sometimes cause or aggravate a fissure.
- Overly Tight Sphincter Muscles: Some people naturally have tighter anal sphincter muscles, increasing the tension in the area and making it more prone to tearing.
Understanding the cause is a key step in both treating the current fissure and preventing future ones.
Recognising the Symptoms: What to Look For
The symptoms of an anal fissure can be alarming, but they are usually quite distinct. Recognising them early can help you seek timely advice and treatment.
Key Symptoms:
- A sharp, tearing, or burning pain during a bowel movement. Some people describe it as feeling like "passing broken glass."
- A deep, burning ache that can last for several hours after a bowel movement. This is caused by spasms in the sphincter muscle.
- Bright red blood on the toilet paper or in the toilet bowl after passing a stool. The bleeding is usually minor.
- A visible tear or crack in the skin around the anus.
- A small skin tag or lump (a sentinel pile) located next to the fissure, more common in chronic cases.
- Itching or irritation around the anal area.
The severity of the pain often makes people fearful of going to the toilet, which can lead to withholding stools. This, in turn, makes constipation worse, creating a vicious cycle of harder stools and further trauma to the fissure.
Getting a Diagnosis: The GP and Specialist Pathway
If you suspect you have an anal fissure, your first port of call should be your GP. They will ask about your symptoms and medical history.
A diagnosis can often be made based on your description of the symptoms alone. However, your GP may need to perform a gentle examination. This usually involves simply looking at the area. In most cases, the fissure is visible, and no internal examination is needed, especially if it's very painful.
The Referral Process:
If your fissure doesn't heal with initial treatments, or if the diagnosis is uncertain, your GP will refer you to a specialist. This is typically a colorectal surgeon or a gastroenterologist.
- NHS Pathway: Your GP makes a referral through the NHS system. You will then join a waiting list to see a specialist.
- Private Pathway: With private medical insurance, your GP can provide an open referral letter. You can then contact your insurer, who will authorise a consultation with a specialist from their approved network. This process is usually much faster.
Anal Fissure Treatment: NHS vs. Private Care
Both the NHS and private sector offer effective treatments for anal fissures. The main difference lies in the speed of access, choice of specialist, and the environment in which you are treated.
According to the latest NHS England statistics (2024), the median waiting time for consultant-led elective care in specialties like general surgery (which covers colorectal issues) can be several months. For patients in significant pain, this wait can be debilitating.
Here’s a comparison of the typical pathways:
| Feature | NHS Pathway | Private Medical Insurance Pathway |
|---|---|---|
| Initial Consultation | Appointment with your GP. | Appointment with your GP. |
| Referral to Specialist | GP refers you; you join the NHS waiting list. | GP provides an open referral; you contact your insurer. |
| Time to See Specialist | Can range from weeks to several months. | Typically within days or a couple of weeks. |
| Choice of Specialist | You are usually assigned to the next available specialist at your local hospital. | You can often choose your specialist and hospital from the insurer's approved list. |
| Treatment Scheduling | Treatment is scheduled based on clinical priority and waiting list length. | Treatment is scheduled at a time convenient for you and the specialist. |
| Hospital Stay | Likely to be in an NHS ward, which may be shared with other patients. | A private en-suite room in a private hospital or the private wing of an NHS hospital. |
| Cost | Free at the point of use. | Covered by your insurance policy (subject to your excess and benefit limits). |
For a condition that significantly impacts daily quality of life, the speed and comfort offered by private care can be a major advantage.
Non-Surgical Treatment Options Explained
Over 90% of acute anal fissures heal without surgery. The goal of non-surgical treatment is to relax the anal sphincter muscle, which improves blood flow to the tear and allows it to heal naturally. It also focuses on keeping stools soft to prevent re-injury.
1. Lifestyle and Dietary Changes (First-Line Treatment)
This is the foundation of all fissure treatment and prevention.
- Increase Fibre Intake: Aim for 30g of fibre per day. This helps to soften stools. Good sources include fruits, vegetables, whole grains, nuts, and seeds.
- Stay Hydrated: Drink 2-3 litres of water daily. This helps the fibre to work effectively.
- Use Stool Softeners: Over-the-counter laxatives like lactulose or macrogol (e.g., Movicol) can be very effective in the short term.
- Warm Baths (Sitz Baths): Soaking the area in warm water for 10-15 minutes, several times a day (especially after a bowel movement), can relax the sphincter muscle and soothe pain.
- Avoid Straining: Don't spend too long on the toilet or strain excessively.
2. Topical Creams and Ointments
If lifestyle changes aren't enough, your doctor may prescribe a special cream.
- Glyceryl Trinitrate (GTN) Ointment (e.g., Rectogesic): This is the most common prescription. It works by relaxing the blood vessels around the anus, which in turn relaxes the sphincter muscle and increases blood flow to the fissure. It's usually applied twice a day for 6-8 weeks. A common side effect is headaches.
- Calcium Channel Blockers (e.g., Diltiazem Cream): This is an alternative if GTN causes severe headaches. It works in a similar way to relax the muscle and has a lower incidence of headaches.
3. Botulinum Toxin (Botox) Injections
For chronic fissures that don't respond to creams, Botox injections are a highly effective second-line treatment.
- How it works: A small amount of Botox is injected directly into the internal anal sphincter muscle. This temporarily paralyses the muscle for about 2-3 months, giving the fissure an excellent chance to heal.
- Procedure: It's a simple outpatient procedure that takes only a few minutes.
- Success Rate: Studies show success rates of 60-90%.
- Availability: Botox is available on the NHS but may be subject to funding restrictions and longer waits. It is widely available through private medical insurance UK policies.
Here is a summary of the non-surgical options:
| Treatment | How It Works | Typical Duration | Common Side Effects |
|---|---|---|---|
| Diet & Lifestyle | Softens stool, reduces straining. | Ongoing | None |
| GTN Ointment | Relaxes sphincter muscle, improves blood flow. | 6-8 weeks | Headaches, dizziness. |
| Diltiazem Cream | Relaxes sphincter muscle, alternative to GTN. | 6-8 weeks | Less likely to cause headaches. |
| Botox Injection | Temporarily paralyses the sphincter muscle. | One-off injection (effect lasts 3 months) | Minor, temporary incontinence to wind or stool. |
Surgical Procedures for Anal Fissures
Surgery is generally reserved for chronic fissures that have failed to heal with all other non-surgical treatments. While it has the highest success rate, it also carries more risks. A colorectal surgeon will discuss the options with you.
1. Lateral Internal Sphincterotomy (LIS)
LIS is considered the 'gold standard' surgical treatment for chronic anal fissures due to its high success rate (over 95%).
- The Procedure: The surgeon makes a very small cut in the internal anal sphincter muscle. This permanently reduces the tension in the muscle, preventing spasms and allowing the fissure to heal. The cut is made away from the fissure itself.
- How it's done: It is usually performed as a day-case procedure under a short general or spinal anaesthetic.
- Recovery: Pain from the fissure often disappears almost immediately. Recovery from the surgery itself is quick, with most people back to normal activities within a week or two.
- The Main Risk: The primary risk is a small chance (around 1 in 20) of developing some degree of long-term incontinence, which is usually minor (e.g., to wind) but can rarely be more significant. Surgeons are very careful to cut only a tiny portion of the muscle to minimise this risk.
2. Fissurectomy and Advancement Flaps
This is an alternative surgical option, sometimes used if a sphincterotomy is considered too risky (e.g., in women who have had a difficult childbirth).
- Fissurectomy: The surgeon removes the fissure itself, along with any scar tissue and the associated skin tag (sentinel pile). This creates a fresh wound that can heal more effectively.
- Advancement Flap: This procedure is often combined with a fissurectomy. The surgeon takes a small piece of healthy tissue from the lining of the rectum and uses it to cover the wound, bringing a fresh blood supply to the area to promote healing.
- Success Rate: Success rates are good, around 80-90%, but slightly lower than for LIS. The risk of incontinence is much lower.
The Role of Private Medical Insurance for Fissure Treatment
Private medical insurance (PMI) is designed to cover the costs of diagnosis and treatment for acute medical conditions. If you develop an anal fissure after your policy has started, it will almost certainly be covered.
How PMI helps:
- Fast-Track Diagnosis: Once you have a GP referral, your PMI policy allows you to bypass NHS queues and see a consultant colorectal surgeon within days.
- Choice of Specialist: You can research and choose from a list of leading specialists approved by your insurer, ensuring you're treated by an expert in the field.
- Access to Advanced Treatments: Your policy will cover the costs of consultations, diagnostic tests, and treatments like Botox injections or surgery if required.
- Comfort and Convenience: Treatment takes place in a private hospital, usually with an en-suite room, flexible visiting hours, and a more comfortable environment for recovery.
At WeCovr, we act as an expert PMI broker, helping you compare policies from the UK's best PMI providers to find a plan that suits your needs and budget. Our service is free, and we provide impartial advice to ensure you understand exactly what is and isn't covered.
Critical Point: Pre-Existing and Chronic Conditions
This is the most important rule to understand about private medical insurance in the UK. Standard PMI policies do not cover pre-existing conditions.
- What is a pre-existing condition? Any illness, injury, or symptom (including an anal fissure) for which you have had symptoms, medication, or advice before the start date of your policy.
- What is a chronic condition? A condition that is long-lasting and cannot be fully cured, only managed. This includes conditions like Crohn's disease, diabetes, or high blood pressure.
If an anal fissure becomes a recurring, long-term problem that requires ongoing management rather than a definitive cure, an insurer might classify it as chronic. In this case, they would cover the initial acute flare-up but may exclude it from future cover.
Underwriting Options:
When you apply for PMI, the insurer will assess your medical history. There are two main ways they do this:
- Moratorium Underwriting: A simple option where any condition you've had in the last 5 years is automatically excluded. However, if you remain symptom-free and treatment-free for that condition for a continuous 2-year period after your policy starts, the exclusion may be lifted.
- Full Medical Underwriting (FMU): You complete a detailed health questionnaire. The insurer reviews your medical history and lists specific conditions that will be permanently excluded from your policy. This provides certainty from day one.
It is vital to be honest about your medical history. Failing to declare a condition can invalidate your policy.
Preventing Anal Fissures: Lifestyle and Diet Tips
Prevention is always better than cure. The same lifestyle habits that help treat a fissure are also the best way to prevent one from ever occurring.
Top Prevention Strategies:
- Eat a High-Fibre Diet: Aim for a mix of soluble fibre (oats, beans, apples) and insoluble fibre (whole grains, nuts) to keep stools soft and bulky.
- Drink Plenty of Fluids: Water is essential for fibre to do its job. Dehydration leads to hard stools.
- Don't Ignore the Urge: Go to the toilet as soon as you feel the need. Holding it in can make stools harder and drier.
- Establish a Routine: Try to have a bowel movement at a similar time each day, such as after breakfast.
- Exercise Regularly: Physical activity helps stimulate the bowels and prevent constipation.
- Be Gentle: Avoid harsh wiping. Use moist toilet paper or a bidet if you have one.
- Use WeCovr's CalorieHero App: As a WeCovr client, you get complimentary access to CalorieHero. This AI-powered app can help you track not only calories but also your daily fibre and water intake, making it easier to stick to your health goals.
Recovery and Aftercare: What to Expect
Recovery depends on the treatment you've had.
- After Non-Surgical Treatment: You can continue with normal life, but it's crucial to stick with the high-fibre diet and hydration to allow the fissure to heal and prevent recurrence.
- After Botox: You may feel some mild discomfort, but you can usually return to work the next day. The muscle relaxation effect will kick in over a few days.
- After Surgery (LIS or Flap):
- You will likely feel sore for a few days to a week. Your surgeon will prescribe painkillers.
- It's essential to keep your stools soft to avoid damaging the healing wound. You'll be advised to take stool softeners for several weeks.
- Warm sitz baths are highly recommended to keep the area clean and soothe discomfort.
- You will usually have a follow-up appointment with your surgeon around 6-8 weeks after the procedure to check that everything has healed properly.
As a WeCovr customer, you may also be eligible for discounts on other types of insurance, such as life or income protection, helping you build a comprehensive financial safety net for your health and wellbeing. Our high customer satisfaction ratings reflect our commitment to supporting our clients through every step of their journey.
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What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
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