An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and undergarments, or sometimes in the toilet. If acute they are painful after defecation,  but with chronic fissures, pain intensity often reduces. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location. Fissure depth may be superficial or sometimes down to the underlying sphincter muscle. Untreated fissures develop a hood like skin tag sentinel piles which cover the fissure and cause discomfort and pain.
Complete anal sphincter complex disruption from intercourse: A case report and literature review
Anal sphincter injury at childbirth | MDedge ObGyn
The surgical management of a consecutive series of 97 patients with complete division of the anal sphincter musculature is reported. The sphincter damage followed operative, traumatic, or obstetric injury and resulted in frank fecal incontinence or the urgent necessity of a defunctioning colostomy. All patients were treated by delayed sphincter repair using an overlapping technique; in 93 the repair was protected by a temporary defunctioning stoma. There were no deaths. Complications occurred in 27 patients but did not usually affect the eventual clinical outcome. Provided there has been no major neurological damage to the sphincter complex, surgical reconstruction can be expected to restore continence in most patients.
Anal sphincter injuries are uncommon injuries outside of obstetric practice — but they may cause disastrous complications. We present a case of complete anal sphincter disruption from anal intercourse in a 25 year old woman. Clinical management is presented and technical details of the repair are discussed. She had an uneventful post-operative course and good continence after days of follow up.
Do you routinely check with new first-time mothers at a postpartum visit about changes in anal continence? They are at particular risk for obstetric anal sphincter injury and could be too embarrassed to raise the issue. Sphincter injury following labor is the most common cause of anal incontinence including flatus in women, which can severely diminish quality of life and lead to considerable personal and financial costs. In this article, we review measures to reduce the occurrence of obstetric anal sphincter injury, proper primary repair when it does occur, and appropriate long-term follow-up.