Anal Fissure

Overview

What is Anal Fissure?
An anal fissure is a small cut in the skin of the anus, where stool leaves the body. It can cause pain and bleeding when you have a bowel movement. This often happens from passing large or hard stools, but can also come from chronic diarrhea or conditions like inflammatory bowel disease. Acute anal fissures usually clear up within a few weeks, but they can become chronic when they take longer to heal or the tissue keeps tearing over and over. Anal fissure treatment usually involves changing your diet, using stool softeners, and sometimes taking medicine to relax the muscles around the anus. In serious cases, surgery might be needed.

Anal Fissure Causes

Anal fissure causes by trauma or injury to the delicate lining of the anal canal. Some common Anal fissure causes include:

• Passing Hard or Large Stools: One of the most common causes of anal fissure is the passage of hard, large, or difficult-to-pass stools. This can happen due to constipation, dehydration, inadequate fiber intake, or certain medications.

• Chronic Diarrhea: Frequent episodes of diarrhea can also irritate and damage the lining of the anus, leading to fissures.

• Straining during Bowel Movements: Excessive straining during and pain after bowel movements, which can occur due to anal fissure constipation or other reasons, can put pressure on the anus and cause tears in the lining.

• Childbirth: Women who have given birth vaginally may develop anal fissures due to the stretching and trauma that occurs during delivery.

• Anal Trauma: Injury to the anal area, such as from anal intercourse, insertion of foreign objects, or aggressive cleaning, can cause fissures.

• Inflammatory Bowel Disease (IBD): Conditions like Crohn’s disease or ulcerative colitis, which cause inflammation and ulcers in the digestive tract, can lead to anal fissures.

• Reduced Blood Flow to the Anal Area: Conditions that reduce blood flow to the anal region, such as anal spasms (hypertonic anal sphincter) or vascular diseases, can impair healing and predispose to fissures.

• Other Medical Conditions: Certain medical conditions like HIV/AIDS, diabetes, or certain infections can weaken the immune system and increase the risk of developing anal fissures.

Anal Fissure Symptoms

The anal fissure symptoms are inclusive of:

Pain During Bowel Movements
One of the most common anal fissure symptoms is intense pain or discomfort during and after passing stools. This pain is often described as sharp, burning, or tearing and may persist for some time after bowel movements.

Rectal Bleeding
Anal fissures typically cause bright red blood on the toilet paper or in the toilet bowl after a bowel movement. The bleeding is usually minimal but can be alarming.

Anal Itching and Irritation
Some individuals may experience itching, irritation, or a sensation of soreness around the anal area.

Tenderness or Sensitivity
The skin around the anus may feel tender or sensitive to touch, particularly near the site of the fissure.

Spasms of the Anal Sphincter Muscle
The muscles surrounding the anus (anal sphincter) may go into spasm, causing additional pain after bowel movements.

Feeling of Incomplete Bowel Movements
Due to the discomfort associated with passing stools, individuals with anal fissures may feel like they haven’t fully evacuated their bowels after a bowel movement.

Visible Tear or Crack
Upon examination, a small tear or crack in the skin around the anus may be visible. This may appear as small, shallow ulceration.

Discomfort with Sitting or Movement
Pain and discomfort from an anal fissure can make sitting or certain movements uncomfortable.

These anal fissure symptoms can vary in severity depending on the size and location of the fissure. Acute fissures often cause more intense symptoms, while chronic fissures may have milder but more persistent symptoms over time.

What are chronic anal fissures symptoms?
Chronic anal fissure symptoms usually involve ongoing pain around the anus, especially during or after using the bathroom. You might also see bright red blood on the toilet paper or in the toilet after you poop. It can cause ongoing discomfort, itching, and sometimes a small flap of skin near the anus.  When you have a chronic anal fissure, one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal.

What does an anal fissure feel like?
An anal fissure often feels like a sharp pain or burning sensation when you go to the bathroom. You might also see bright red blood on the toilet paper or in the toilet. Most anal fissures get better without treatment.

How long does anal fissure last?
The time it takes for an anal fissure to heal can vary. An acute anal fissure usually get better within a few weeks with medical treatment. A chronic fissure might take longer to heal, possibly lasting for months without treatment. 

Anal Fissure Diagnosis

For anal fissure diagnosis, a primary care physician will follow these steps:

• Medical History: The physician will ask about your anal fissure symptoms, especially any pain or bleeding during bowel movements. They’ll want to know about your diet, bowel habits, and history of anal fissure constipation or diarrhea.

• Physical Examination: The physician will look at the area around your anus to check for signs of an anal fissure, like a small tear. They may gently feel the area to check for tenderness.

• Digital Rectal Examination (DRE): Sometimes, the physician will insert a lubricated, gloved finger into your rectum to feel for internal issues.

• Anoscopy or Proctoscopy: If needed, the primary care physician might use a small, lighted tool to look inside your anal canal and lower rectum for a closer look at any fissures.

• Colonoscopy (in certain cases): If there are concerns about other conditions like inflammatory bowel disease or cancer, a colonoscopy might be recommended to examine the entire colon and rectum.

• Additional Tests: Rarely, additional tests like imaging scans or tissue biopsy may be needed if the anal fissure diagnosis is still unclear.

Based on these exams and tests, the physician will determine if you have an anal fissure or another issue causing your symptoms. Anal fissure treatment will depend on the findings and how severe your signs of anal fissure are.

Are anal fissures dangerous?
Anal fissures are usually not dangerous, but they can be uncomfortable and cause pain or bleeding. If they are not treated or become chronic, they can lead to ongoing anal fissure symptoms that affect how you feel every day. 

Treatment

Anal fissure treatment aims to ease symptoms, help the fissure heal, and prevent it from coming back. Anal fissure treatments can vary depending on how bad the fissure is and how long you’ve had it. Here are common ways to treat anal fissures:

• Fruits, vegetables, and whole grains can make stools softer and bowel movements easier.
• Staying hydrated prevents constipation.
• Straining on the toilet can make fissures worse. Try relaxation techniques and don’t sit on the toilet for too long.
• Regular exercise helps keep bowel movements regular.
• Numbing creams (like lidocaine) can reduce pain.
• Creams with calcium channel blockers (like diltiazem or nifedipine) relax muscles and help the fissure heal.
• Use stool softeners and laxatives, helping to make stools softer and prevent strain during bowel movements.
• Avoid spicy foods.
• Take a warm bath several times a day to soothe the area and promote healing.
• Inject Botox into the muscle to relax it and improve blood flow for healing.
• Surgery options include cutting a muscle to reduce pressure on the fissure (lateral internal sphincterotomy) or removing the fissure tissue (fissurectomy).
• Laser therapy or using nitroglycerin ointment are also options in some cases.

How to treat sores on the anus?
To heal anal fissures and hemorrhoids, wash gently with warm water and mild soap. Apply over-the-counter creams like petroleum jelly or zinc oxide for relief. If the sores don’t get better or get worse, visit a primary care physician for more help and anal fissure treatment.

How to prevent anal fissures?
To prevent anal fissures, maintain regular bowel movements by eating a high-fiber diet and drinking plenty of water. Avoid straining during bowel movements and practice good anal hygiene to keep the area clean and healthy. These anal fissures self-care is vital to prevent anal fissures. 

When To See A Doctor

You should see a physician for an anal fissure if you experience persistent anal pain, rectal bleeding, or changes in bowel habits that don’t improve with home care. Seek medical attention if you have recurrent anal fissure symptoms, discomfort while sitting, or concerns about your anal health. Prompt evaluation by a healthcare provider can lead to appropriate anal fissure diagnosis and treatment to relieve symptoms and prevent complications.

Summary

An anal fissure is a small tear in the lining of the anus, often caused by passing hard or large stools, chronic diarrhea, or trauma during childbirth. It can result in sharp pain during bowel movements, rectal bleeding, and discomfort, making it difficult to sit or move comfortably. Anal fissures are classified as acute if they heal within a few weeks, or chronic if they last more than eight weeks. Chronic fissures may cause ongoing symptoms, including pain, itching, and a visible tear in the anal area.

Anal fissures are a common condition, affecting up to 10% of the population at some point in their lives, with the highest incidence occurring in adults aged 30 to 50. Around 90% of acute fissures can heal with non-surgical treatment, but about 40% of chronic fissures may require further medical intervention, including surgery or Botox injections.

The primary causes of anal fissures include straining during bowel movements, anal trauma, inflammatory bowel diseases like Crohn’s disease or ulcerative colitis, and reduced blood flow to the anal region. Symptoms include sharp pain, bright red bleeding, itching, and anal sphincter muscle spasms. These symptoms can vary in severity depending on the type of fissure and the extent of the injury.

Treatment for anal fissures usually involves increasing fiber intake, staying hydrated, and using stool softeners to make bowel movements easier. Topical creams, such as numbing agents or calcium channel blockers, can help relieve pain and relax the anal sphincter muscles. In more severe cases, Botox injections or surgery may be required to reduce pressure on the fissure and promote healing.

Preventing anal fissures involves maintaining regular bowel movements by consuming a high-fiber diet, drinking plenty of water, and avoiding straining during bowel movements. It’s important to see a healthcare provider if symptoms persist, as untreated fissures can lead to chronic discomfort. 

-Disclaimer-

This information is intended for educational purposes only and should not be considered a substitute for professional medical advice. If you have concerns about anal fissure or any other medical condition, please see a primary care physician for an accurate anal fissure diagnosis and personalized treatment suggestions.