Anal fissure

An anal fissure is a painful tear or ulcer near the anus, developing in the lining of the large intestine.

Common symptoms include:

  • Bleeding
  • A sharp pain when emptying your bowel, which can continue for several hours afterwards

It is important to seek medical advice if you think you may be suffering from an anal fissure. Although anal fissures mostly improve in time without treatment, a GP would want to eliminate other things such as haemorrhoids.


If a patient suffering from an anal fissure is struggling to poo, laxatives can be prescribed to make going to the toilet easier. In addition, special creams or ointments are prescribed which can speed up healing. In cases where an anal fissure returns, surgery may be recommended.

Anal fissures mostly heal within a few weeks, however it is crucial to be vigilant as they can easily return, particularly if caused by constipation.

To avoid constipation, a fibre-rich diet is recommended, as well as maintaining hydration and not putting off going to the toilet.


Anal fistula

An anal fistula is most often caused by an infection starting in the anal glands. This infection causes an abscess that can drain on its own, however surgery is often required.

The most common symptoms include:

  • A red, inflamed area around the anus
  • Rectal and anal pain
  • Fever and chills
  • Blood or pus on the stool, or coming from the back passage

An anal fistula usually requires surgery, as generally they do not heal without medical intervention.

Surgical options include:

  • Fistulotomy – a cut is made along the length of the fistula to open it up so it heals as a flat scar
    A surgeon will consider the risk of bowel incontinence through cutting a small section of the anal sphincter muscle during the surgery. If the risk is considered too high, other surgeries may be considered.
  • Seton technique – this involves the insertion of a seton (a large surgical thread) into the fistula for several weeks in order to keep it open to promote healing. This allows it to drain and eliminates the risk of causing incontinence through surgery
  • Advancement flap procedure – cutting or scraping out the fistula, and covering the hole where it entered the bowel with a flap of tissue from inside the rectum

Non-surgical treatment

Non-surgical treatment for anal fistulas involves using fibrin glue. While overall less effective than a fistulotomy, it may be beneficial for fistulas that pass through the anal sphincter muscles as they don’t need to be cut. Your specialist will advise you on the best treatment option.

Pilonidal sinus

Pilonidal sinus is a skin condition causing a small hole or tunnel in the skin at the top of the buttocks. It is a condition that largely goes unnoticed unless it results in an infection.

An infection will cause pain and swelling, which can lead to a pus-filled abscess. Without symptoms of infection, medical treatment is not required. A pilonidal sinus abscess will require a course of antibiotics, as well as probably needing to be drained. Painkillers can help with the pain and swelling.

Common symptoms include:

  • Leaking discharge or pus
  • Pain and aching
  • Bleeding

In abscesses that are considered minor, an incision and drainage procedure is carried out, which involves making a small hole in the abscess so that it can be drained. Either local or general anaesthetic will be used, depending on the size of the abscess. For larger or repeatedly infected sinuses, general anaesthetic is used, as the sinus is cut out and some skin around the area is removed. This treatment type requires daily dressing changes, but bears a low risk of the sinus returning.

Other surgical options include a procedure to remove the sinus and surgery to clean the sinus. Your specialist will advise you on the best treatment option.

Lumps and bumps

Lumps and bumps around the anus, including anal skin tags and warts, are very common. Anal skin tags are harmless, and often feel like small bumps or raised areas around the anus. It is not uncommon to have several anal skin tags at once. They are pieces of excess tissue that do not result in pain or bleeding, but can be uncomfortable and cause itching.

Lumps and bumps around the anal area are often caused by conditions such as haemorrhoids or anal fissures.

    Anal warts

    Anal warts are located in and around the anus. They are caused by HPV (human papilloma virus), which is spread by sexual contact or skin to skin contact. They feel like soft bumps and are generally flesh coloured. Symptoms of anal warts include bleeding and itching. Topical ointments can treat anal warts considered to be small; larger warts may require surgery. Your specialist will advise you on the best treatment option.

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