I have an anal fissure, have you come across this?

Dear Karen,

I thought I had piles, but my GP told me that I have an anal fissure. It is very painful. Have you come across this?
 
KAREN SAYS: An anal fissure is a crack on the anal rim. Men and women are equally affected and the 20 to 30-year old age group are most impacted by this condition.
 
I know it can be a very painful condition and passing stools is very difficult. It can sometimes be caused by constipation and a wide, hard stool. Occasionally there can be an underlying inflammatory bowel disease, e.g. Crohn’s.
 
You need laxatives to soften the stool at the moment and make them easier to pass. Topical nitrates are used for four to eight weeks to try and facilitate healing. This form of treatment can cause headaches.
 
If this treatment doesn’t work, referral for surgical treatment or even a botox injection may be required.