Description

An anal fissure is a small tear in the thin, moist tissue that lines the anus. The anus is the opening at the end of the digestive tract where stool leaves the body. The common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus, called the anal sphincter.

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as eating more fiber or soak in warm water of the tub. Some people with anal fissures may need medication. Sometimes, surgery may be necessary.

Symptoms

The symptoms of an anal fissure include:

  • Pain during bowel movements.
  • Pain after bowel movements that can last up to several hours.
  • Bright red blood in the stool or on the toilet paper after a bowel movement.
  • A visible crack in the skin around the anus.
  • A small lump or skin tag near the anal fissure.

When to see a doctor

Consult a health care professional if you have pain during bowel movements or notice blood in the stool or on the toilet paper after a bowel movement.

Causes

The common causes of anal fissures include:

  • Passing large or hard stools.
  • Constipation and straining during defecation.
  • Long duration of diarrhea.
  • Anal intercourse.
  • Delivery.

Less common causes of anal fissures include:

  • Crohn's disease or other inflammatory bowel disease.
  • The Anal cancer.
  • HIV .
  • Tuberculosis.
  • Syphilis.

Risk factors

Factors that may increase the risk of developing an anal fissure include:

  • The constipation. Straining during bowel movements and passing hard stools increase the risk of breakage.
  • Delivery. Anal fissures are more common in women after giving birth.
  • Crohn's disease. This inflammatory bowel disease that causes chronic inflammation of the intestinal tract. This can cause the lining of the anal canal more vulnerable to breakage.
  • Anal intercourse.
  • Age. Anal fissures can occur at any age, but are most common in infants and middle-aged adults.

Complications

Complications of anal fissure may include:

  • If you do not heal. An anal fissure that does not heal within eight weeks is considered chronic and may need additional treatment.
  • Recurrence. Once you've experienced an anal fissure, which are likely to have another.
  • A tear that extends to the surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed. This muscle is called the internal anal sphincter. If this happens, it makes it more difficult for the anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require the use of medications or surgery to ease the pain and to repair or remove the fissure.

Prevention

You may be able to prevent anal fissure, through the adoption of measures to prevent constipation or diarrhea. Eat foods rich in fiber, drink fluids and exercise regularly in order to avoid having to strain during bowel movements.

Diagnosis

A health professional will likely ask about your medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually, this test is all that is needed to diagnose an anal fissure.

A more recent, anal fissure, acute it looks like a fresh tear, somewhat like a paper cut. A full-length, also called chronic anal fissure likely has a deeper tear. You can also have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.

The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, in place of the front or rear, is more likely to be a symptom of another disease, such as Crohn's disease. A medical professional may recommend additional tests to find out if there is an underlying condition. Tests may include:

  • Anoscopy. An anoscope is a tubular device inserted into the anus to help to see the rectum and the anus.
  • Flexible sigmoidoscopy. In this test, a thin, flexible tube with a small camera attached is inserted into the lower portion of the colon. This test can be performed by people under the age of 45 years who do not have risk factors for bowel disease or colon cancer.
  • Colonoscopy. This test consists in the insertion of a flexible tube into the rectum to inspect the entire colon. Colonoscopy may be done for someone who: Is greater than 45 years.You have risk factors for colon cancer.You have symptoms of other conditions.You have other symptoms, such as stomach pain, or diarrhea.
  • It is over 45 years old.
  • You have risk factors for colon cancer.
  • You have symptoms of other conditions.
  • You have other symptoms, such as stomach pain, or diarrhea.
  • It is over 45 years old.
  • You have risk factors for colon cancer.
  • You have symptoms of other conditions.
  • You have other symptoms, such as stomach pain, or diarrhea.

Treatment

Anal fissures often heal within a few weeks with proper treatment in the home. Take measures to keep the stool soft, such as increasing your intake of fiber and fluids. Soak in warm water for 10 to 20 minutes several times a day, especially after bowel movements. This can help relax the sphincter and promote healing. If symptoms persist, it is likely that you will need more treatment.

The non-surgical treatments

A health professional may recommend the following:

  • The external application of nitroglycerin (Rectiv) can help to increase blood flow to the fissure and promote healing. It can also help to relax the anal sphincter. Nitroglycerin is generally considered the treatment of choice when other conservative measures fail. Side effects may include headache, which may be serious.
  • Topical anesthetic creams such as lidocaine (Xylocaine) may help relieve the pain.
  • OnabotulinumtoxinA (Botox) injection paralyzes the muscle of the anal sphincter and relaxes the spasms.
  • Blood pressure medications, such as nifedipine or diltiazem, help to relax the anal sphincter. These medications are generally applied to the skin, but it can also be taken by mouth. However, when taken by the mouth, their side effects may be greater. These medicines may be used when the nitroglycerin is not effective or cause serious side effects.

Surgery

If you have a chronic anal fissure, which is resistant to other treatments, or if your symptoms are severe, surgery may be recommended. Surgeons often perform a procedure called a lateral internal sphincterotomy (LIS). LIS involves cutting a small part of the anal sphincter muscle. This technique can help promote healing and reduce the spasm and pain.

Studies show that surgery is much more effective than any medical treatment for chronic fissure. However, the surgery has a small risk of causing incontinence.

Lifestyle and home remedies

Several lifestyle changes can help relieve discomfort and promote healing of an anal fissure, as well as to prevent a recurrence. The changes include:

  • Add fiber to your diet. Eating about 25 to 35 grams of fiber a day can help keep the stools soft and improve the healing of the fissure. Foods rich in fiber include fruits, vegetables, nuts and whole grains. You can also take a fiber supplement. The addition of fiber can cause gas and bloating, so increase your intake gradually.
  • Drinking the right amount of liquid. Fluids help prevent constipation.
  • Not straining during a bowel movement. Effort creates pressure, which can open the healing of a tear or cause a new tear.
  • Sitting in a hot bath. It is also called a sitz bath, soaking in a warm bath of water for 10 to 20 minutes several times a day can soothe the skin and promote relaxation. If possible, take a sitz bath after defecation.

If your baby has an anal fissure, change diapers often, and wash the area gently. Also, make sure to discuss the problem with your child's healthcare team.

Preparing for your appointment

If you have an anal fissure, you may be referred to a doctor who specializes in diseases of the digestive system, called a gastroenterologist, or a colon and rectal surgeon.

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Before your appointment:

  • Make a list of your symptoms, even if they may seem unrelated to the reason for your appointment.
  • Write down key personal information, including major stresses, recent life changes and family medical history.
  • Bring a list of all medications, vitamins or supplements that you are taking, including the dosage.
  • Take someone with you. If possible, bring a family member or friend with you to help you to remember the things that you may forget.
  • Prepare questions during your appointment.

Some basic questions to ask include:

  • What is likely causing my symptoms?
  • There are other possible causes of the symptoms?
  • Do I need any tests?
  • Is my condition likely temporary or chronic?
  • What are some diet tips that you should follow?
  • There are restrictions that must be followed?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

You may ask:

  • When did you begin experiencing symptoms?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • Where do you feel that your symptoms?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you have other medical conditions, such as Crohn's disease?
  • Do you have problems with constipation?

What you can do in the meantime

While you are waiting to see their healthcare provider, to take steps to avoid constipation, such as:

  • Drink lots of water.
  • Add fiber to your diet.
  • Exercising on a regular basis.

In addition, do not strain during bowel movements. The extra pressure can extend the fissure or create a new one.

Symptoms and treatment of Anal fissure