Complications of anal fissures may result from recurrence, inability to heal, or from treatments used. The risk of a subsequent anal fissure is increased in persons who have had a previous anal fissure.
The main complication associated with acute fissures is an inability to heal. An anal fissure that does not heal within a few weeks becomes chronic. These anal fissures become deeper and form ulcers. If the anal fissure extends into the internal anal sphincter muscle (the muscle that holds the anus closed) and spasms, it may impair blood supply to the fissure, reducing the ability to heal. In the case of a chronic, nonhealing ulcer, infection by fecal bacteria (bacteria in the stool) is possible.
An increased risk of anal cancer is associated with previous development of anal fissures.
Complications may also occur from treatments used for anal fissure. Surgery is often used to treat a chronic anal fissure. Surgery for chronic fissure may result in the development of acute (during the surgical recovery period) or chronic, usually mild anal incontinence (lack of control of the bladder), including inability to control gas, fecal soiling, and fecal loss. Other complications of surgery include postoperative pain or slow healing of the incision, hematoma or ecchymosis (bruising), abscesses, hemorrhage, and urinary incontinence (lack of control of the bladder), as well as recurrent fissures.
Complications of botulinum toxin (another potential treatment) include gas or fecal incontinence, as well as blood clotting or bruising around the anus. Flu-like symptoms and swelling of the epididymis (the tube that connects the testicle with the vas deferens) have been reported rarely. Adverse effects are considered short-term and reversible.
Complications of topical nitroglycerin (occasionally used to relax the anal sphincter muscle) include headaches, low blood pressure, and dizziness. Anal itch and allergic dermatitis have been reported rarely.
Complications of increasing fiber in the diet include gas or bloating.
In infants, those with a previous episode of abscess or pus at the time of surgery were more likely to have recurring anal fissures.
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