Massive bleeding is rare. Diagnosis and Treatment Fissures can usually be seen when the buttocks are separated and the patient strains. They usually occur at the posterior midline but occasionally occur at the anterior midline. For some patients, the examination is so painful and causes so much spasm of the sphincter that local or general anesthesia is needed. Topical creams or ointments containing local anesthetics or simple protectants may provide relief when applied after bowel movements.
Chronic fissures require surgical intervention.
Internal sphincterotomy, a relatively simple procedure using a local, regional, or general anesthetic, is most commonly performed. It relieves pain and allows healing. Other procedures pose a higher risk of permanent incontinence. Perianal and Ischiorectal Abscesses Localized collections of pus resulting from infections of the pararectal spaces. Abscesses may cause substantial tissue destruction.