An anal fissure refers to a small, oval-shaped tear in the thin, moist tissue (mucosa) that lines the opening of the anus. The condition typically causes severe pain and bleeding with bowel movements. Patients may also experience spasms in the ring of muscle at the end of the anus (anal sphincter). Even though this bowel condition can affect people of any age group, it is more common in young infants. In most cases, anal fissures get better with simple self-treatment remedies like increasing the intake of fiber and fluids. In other severe cases, people may need medication or occasionally, surgery. Gastroenterologists and other specialists who happen to treat this condition need to correctly document the same in patient medical records. Opting for medical billing services from an established medical billing company can help simplify the documentation process.

Here are some frequently asked questions and answers about anal fissure –

What causes an anal fissure?

Fissures are usually caused by trauma to the inner lining of the anus. Hard, dry bowel movement is typically responsible for this condition. Chronic constipation or frequent diarrhea can also tear the skin around the anus. Other common causes of this condition include – straining during bowel movements/childbirth, reduced blood flow to the anorectal area, overly tight or spastic anal sphincter muscles and inflammatory bowel disease (IBD) such as Crohn’s disease and ulcerative colitis.

What are the different types of anal fissures?

Anal fissures can be either acute or chronic. Acute (recent onset) fissures may have the appearance of a simple tear in the anus. Chronic fissures, on the other hand, may have swelling and scar tissue present and may typically last for more than 8-12 weeks. Chronic fissures may be more difficult to treat and may also have an external lump associated with the tear (called a sentinel pile or skin tag) as well as an extra tissue just inside the anal canal, referred to as a hypertrophied papilla.

Where do these fissures commonly occur?

Generally, fissures (about 85-90%) occur in the posterior (back) midline of the anus and about 10-15% occur in the anterior (front) midline of the anus. However, in some cases, a small number of patients may actually have fissures in both the front and the back locations. Fissures located elsewhere (off to the side) may increase the risk of complication related to other diseases and hence will require a detailed examination.

What are the symptoms of an anal fissure?

Pain and bleeding with bowel movements are typical symptoms of an anal fissure. Patients may experience severe pain during, and particularly after a bowel movement which may generally last for several minutes to a few hours. Other related symptoms include – bright red blood on the stool or toilet paper (after a bowel movement), a visible crack in the skin around the anus and a small lump or skin tag on the skin near the anal fissure.

Who is at risk for an anal fissure?

Anal fissures can occur to both men and women. They are quite common during infancy as well. Adults in the age group of 20-40 years are most likely to suffer from this condition. Even though people can get this condition at any age, the risk generally increases as people get older. Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. During and after childbirth, women are at risk for anal fissures due to straining during delivery. Anal fissures more often occur with certain medical conditions such as constipation, anal cancer, leukemia, STDs and HIV and complications from other conditions, like Crohn’s or ulcerative colitis.

How is an anal fissure diagnosed?

Diagnosis of an anal fissure starts with a medical history review and physical exam including a gentle inspection of the anal region. However, physicians will need to perform a rectal exam to confirm the diagnosis. During this exam, the physician may insert an anoscope (a thin tube to inspect the anal canal) into your rectum to inspect the anal canal and see the tear. Using an anoscope may also help your physician to find other causes of anal or rectal pain such as hemorrhoids. On the other hand, in some cases of rectal pain, physicians may conduct an endoscopy to better evaluate the symptoms.
Generally, the location of the fissure indicates about its causes. A fissure that occurs on the side of the anal opening (rather than the back or front) is more likely to be a sign of another disorder, such as Crohn’s disease. Physicians may recommend further tests like Flexible sigmoidoscopy and Colonoscopy, if they think that the patient suffers from other underlying conditions.

How is anal fissure treated and documented?

Most cases of anal fissures do not require extensive treatment. However, certain self-care remedies can help promote healing and relieve uncomfortable symptoms. Self-care remedies include increasing intake of fiber-rich foods, drinking more fluids, using over-the-counter stool softeners, applying a nitroglycerin ointment (to promote blood flow to the area), taking a sitz bath to relax the anal muscles and applying topical pain relievers such as lidocaine to help ease discomfort. In some cases, wherein the patient’s symptoms do not subside even after initial treatment, physicians may recommend other treatment options like calcium channel blocker ointment (to relax the sphincter muscles and allow the anal fissure to heal) and Botox injections into the anal sphincter (to prevent spasms in the anus by temporarily paralyzing the muscle).

If any of the above non-surgical treatments do not improve your symptoms, physicians may recommend surgery as a final option. Physicians generally perform lateral internal sphincterotomy (LIS) – a procedure which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Gastroenterologists, colon and rectal surgeons and other specialists who provide specialized treatment are reimbursed for the services provided to the patients. The correct medical codes must be used to document the diagnosis, screening and other procedures performed. Medical billing and coding services offered by reputable companies can help physicians use the correct codes for their medical billing process.

What ICD-10 codes are used for diagnosing anal fissures?

The following ICD-10 codes are relevant with regard to “anal fissures” –

  • K60 – Fissure and fistula of anal and rectal regions
    • K60.0 – Acute anal fissure
    • K60.1 – Chronic anal fissure
    • K60.2 – Anal fissure, unspecified
    • K60.3 – Anal fistula
    • K60.4 – Rectal fistula
    • K60.5 – Anorectal fistula

How long is the recovery after surgery?

Complete healing can take up to approximately 6-10 weeks. However, acute pain after surgery often disappears after a few days. In most cases, patients will be able to return to work and resume daily activities in a few short days after the surgery.

What measures can be taken to prevent an anal fissure?

An anal fissure cannot always be prevented, but it is possible to reduce the risk of suffering this condition by taking some preventive measures like –

  • Drinking plenty of fluids, eating fibrous foods
  • Exercising regularly to avoid constipation
  • Cleansing the anal area gently with mild soap and warm water
  • Keeping the anal area dry
  • Treating diarrhea immediately
  • Avoid straining during bowel movements
  • For infants with this disease, change diapers frequently