Excretory Orifice fissure is a tear in the inside lining of the wall of the Excretory Orifice. It is caused by the passage of very hard stools and strong pressing and a predisposition for this condition. The symptoms are clear and consist of very severe pain as the stool passes as well as itching, burning, bleeding and wet discharge from the Excretory Orifice. The diagnosis is based on digital rectal examination and simple stretching of the skin of the Excretory Orifice.
Excretory Orifice fissures are usually treated by nitroglycerin ointment which has to be applied to the Excretory Orifice for 2 weeks. A high-fiber diet is also recommended to maintain softness in the stools.
If this therapy is not successful, botulinum toxin may be injected into the Excretory Orifice sphincter.
If this therapy fails as well, surgical correction consists of a small operation to cut a portion of the internal Excretory Orifice sphincter muscle with excision of the fissure.