Anal Fissure

What is an anal fissure?

The term anal fissure describes a tear or a small cut on the anal lining. This tear causes severe pain and some hemorrhage (bright red bleeding) during bowel movements and after bowel movements. In some cases, the fissure may be so deep that it exposes the muscle tissue beneath.

In many cases, an anal fissure is not serious. It is not age-specific, anyone may be affected. However, it occurs often in young children and infants since these groups usually suffer from constipation.

In some cases, the tear heals within a month to six weeks. If the fissure persists beyond two months, then it is considered chronic.

Healing of anal fissures may be enhanced with certain treatments. These treatments also relieve discomfort. They include topical pain relievers and stool softeners.

If these treatment does not improve anal fissure, then you may need a surgery. Your physician may look up for other underlying medical conditions that may cause these fissures.

The symptoms of an anal fissure

The following symptoms are characteristic of an anal fissure:

  • A skin tag, or a small lump of skin lying in close proximity to the tear
  • A tear in the skin. It is visible around the anus
  • A prick in the anal region during bowel movements
  • Itching or burning sensation in the anal area
  • Blood streaks on stools or on the toilet paper after cleaning.

Anal fissure
Photo Credit: JAMA Network

The causes of anal fissure

Anal fissure occurs when one passes very hard stools or very large stools. Frequent diarrhea or chronic constipation may also cause a tear in the skin surrounding the anus. Other causes of anal fissure include:

  • Straining during bowel movements or childbirth
  • Reduction in blood flow to the anorectal area
  • Inflammatory bowel disease (for instance Crohn’s disease)
  • Spastic or overly tight anal sphincter muscles

In rare cases, the anal fissure may be a complication of:

Who is at risk for an anal fissure?

Anal fissures occur commonly during infancy. The elderly are also at risk due to a reduction in blood flow to the anorectal area. Women are also at risk during and after childbirth due to straining during delivery.

The risk of developing this disorder is also high in people with inflammatory bowel disease. The inflammation that occurs in the lining of the intestines makes the anal tissue more prone to tearing. Another risk factor for anal fissure is consistent constipation. Passing large, hard stools and straining are the major causes of anal fissure.

Diagnosis of anal fissure

Anal fissure is diagnosed by simply examining the area around the anus. A rectal exam may be carried out to verify the diagnosis.

During the rectal exam, an anoscope may be inserted into your rectum to make the tear more visible. The anoscope is a thin device that allows physicians to inspect the anal canal. With an anoscope, the physician may also discover other causes of rectal or anal pain like hemorrhoids. In some cases of rectal pain, you may need an endoscopy for accurate evaluation of symptoms.

Treatment for anal fissure

In many cases, an anal fissure would not require extensive treatment. However, some home remedies may facilitate healing and relieve pain or other uncomfortable symptoms. Home treatments for anal fissure include;

  • Drinking more fluids
  • Using OTC stool softeners
  • Consuming fibrous foods like vegetables and raw fruits, and also, fiber supplements.
  • Frequent sitz baths would help relieve irritation, relax the muscles of the anus, and boost the flow of blood to the anorectal area.
  • Inflammation may be relieved with hydrocortisone cream (like Cortizone 10). You may also boost blood flow to the area by applying a nitroglycerin ointment.
  • Use of topical pain relievers such as lidocaine to ease discomfort.

If the symptoms do not get relived after two weeks of treatment, then consult your physician. The physician will carry out a confirmatory diagnosis and draw up a more effective plan of treatment.

A calcium channel blocker ointment can relax the sphincter muscles and boost the healing of the anal fissure.

Botox injections are another possible form of treatment. These are injected directly into the anal sphincter. These injections inhibit anal spasms by temporarily paralyzing the muscle. This will facilitate the healing of the fissure while preventing the formation of new fissures.

If the anal fissure does not respond to other treatments, then an anal sphincterotomy may be recommended. This is a surgical procedure that involves making a small incision in the anal sphincter, the aim of which is to relax the muscle. When the muscles are relaxed, the anal fissure heals faster.

Not all fissures indicates constipation or low fiber diet. Anal fissure that takes time to heal or those that are situated in a position other than the midline or posterior portion of the anus may indicate an underlying medical condition.

If your fissure fails to heal after trying many home remedies, please consult your physician.

Prevention of anal fissure

You cannot prevent an anal fissure, but you can reduce the risk of having one by adopting the following preventive measures:

  • Ensure the anal area is dry at all times
  • Clean the anal region always with warm water and mild soap
  • Keep constipation at bay by drinking much fluids, exercising regularly and eating fibrous foods.
  • Treat diarrhea immediately.
  • Change diapers frequently (for infants).

Takeaway

An anal fissure is characterized by bright red bleeding and sharp pain during bowel movements.  If it progresses to the chronic stage, then skin tags may develop.

Conditions that are linked with anal fissure include inflammatory bowel disease, local cancers, previous anal surgeries, and STDs.

Conditions that may result in an anal fissure are the ones that induce trauma such as anal sex, passing hard stool, and vaginal delivery.