Anal Fissures Causes, Symptoms, Diagnosis, Treatment, Prevention,Home Remedies

Anal Fissures Causes, Symptoms, Diagnosis, Treatment, Prevention,Home Remedies

What is an anal fissure?

An anal fissure is a small tear of the skin of the anus. Although the tear of an anal fissure is usually small (usually less than a centimetre), it can be very painful because the anus is very sensitive. The pain tends to be worse when you pass faeces (sometimes called stools or motions) and for an hour or so after passing faeces. Often an anal fissure will bleed a little. You may notice blood after you pass faeces. The blood is usually bright red, and stains the toilet tissue, but soon stops.

Anal fissures are common in both adults and children. They are not usually serious, but they are sore and can be distressing, particularly for children.

In most people the fissure heals within 1-2 weeks or so, just like any other small cut of the skin. Some fissures take longer to heal. A fissure that lasts more than six weeks is called a chronic anal fissure (chronic means persistent.) This is uncommon, but treatment can still be effective.

Most anal fissures camera heal with home treatment after a few days or weeks (acute anal fissures). If you have an anal fissure that has not healed after 6 weeks, it is considered a long-term problem (chronic). You may need medicine to help a chronic anal fissure heal. Surgery may be necessary for fissures that do not heal with medicine.

Sometimes an anal fissure and a hemorrhoid develop at the same time.

Read more: Anaphylaxis Causes, Symptoms, Diagnosis, Treatment, Prevention

What causes an anal fissure?

Anal fissures can be caused by trauma to the anus and anal canal.

The cause of the trauma can be one or more of the following:

  • Chronic constipation
  • Straining to have a bowel movement, especially if the stool is large, hard, and/or dry
  • Prolonged diarrhea
  • Anal sex, anal stretching
  • Insertion of foreign objects into the anus

Other causes of anal fissures (other than trauma) include:

  • Longstanding poor bowel habits
  • Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)
  • Scarring in the anorectal area
  • Presence of an underlying medical problem: such as Crohn’s disease and ulcerative colitis [types of inflammatory bowel disease]; anal cancer; leukemia; infectious diseases (such as tuberculosis); and sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
  • Decreased blood flow to the anorectal area
Anal fissures are also common in women after childbirth and in young infants.

Risk factors of Anal Fissures

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

Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why.

Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area.

Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.
Childbirth. Anal fissures are more common in women after they give birth.

Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.

What are the signs and symptoms of an anal fissure?

An anal fissure causes a sharp, stinging, or burning pain during a bowel movement. The pain, which can be severe, may last for a few hours. Signs and symptoms include:

  • Pain during, and even hours after, a bowel movement
  • Constipation
  • Blood on the outside surface of the stool
  • Blood on toilet tissue or wipes
  • A visible crack or tear in the anus or anal canal
  • Burning and itch that may be painful
  • Discomfort when urinating, frequent urination, or inability to urinate
  • Foul-smelling discharge

Sometimes an anal fissure may be a painless wound that won't heal and that bleeds intermittently but causes no other symptoms.

Complications of anal fissure

Anal fissures aren’t associated with more serious diseases, such as bowel cancer, although cancer of the anus may mimic an anal fissure. Some of the possible complications of an anal fissure include:
  • Chronic anal fissure – the tear fails to heal. Over time, this can cause extensive scar tissue at the site of the fissure (sentinel pile).
  • Anal fistulas – abnormal ‘tunnels’ join the anal canal to surrounding organs, usually other parts of the bowel.
  • Anal stenosis – the anal canal becomes abnormally narrowed either due to spasm of the anal sphincter or contraction of the resultant scar tissue.

How is an anal fissure diagnosed?

Most doctors can diagnose an anal fissure from symptoms and by looking at the anus. Usually, the doctor can see the fissure by gently separating the buttocks.

A doctor may use a gloved finger (digital rectal examination) or a lighted instrument (anoscope) to examine the fissure. But if the fissure is extremely painful, the doctor will usually wait until it has begun to heal before performing a rectal exam or using an anoscope (anoscopy) to rule out other problems. A topical anesthetic may be used if an immediate examination is necessary.

During an exam, a doctor can also find out whether another condition may be causing the fissure. If you have several fissures or have one or more in an area of the anus where fissures usually do not occur, you may have another condition such as inflammatory bowel disease, syphilis, a suppressed immune system, tuberculosis, HIV infection, or anal cancer. Most fissures occur along the midline-the top or bottom-of the anus.

How are anal fissures treated?

The goal of treatment is to lower the pressure on the anal canal by making stools soft as well as easing discomfort and bleeding. Conservative treatments are tried first and include one or more of the following:

  • Preventing constipation through the use of stool softeners, increased intake of fluids while avoiding caffeine-containing products (which cause dehydration), and dietary adjustments (increase in intake of high fiber foods and fiber supplements)
  • Soaking in a warm bath (also called a sitz bath), 10 to 20 minutes several times a day, to promote the relaxation of the anal muscles
  • Cleansing the anorectal area more gently
  • Avoiding straining or prolonged sitting on the toilet
  • Using petroleum jelly to help lubricate the anorectal area

The conservative practices mentioned above heal most fissures (80 to 90 percent) within several weeks to several months. However, when treatments fail and anal fissures persist or recur other measures can be tried, including:

  • Using hydrocortisone-containing suppositories, foams, or creams to reduce inflammation
  • Applying other creams and ointments -- a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), nitroglycerin or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing)
  • Injecting botulinum toxin type A (Botox) into the anal sphincter. The injection temporarily paralyzes the anal sphincter muscle, relieving pain and promoting healing
  • Surgery

Anal fissures in children

The above measures apply to children who have a fissure as much as to adults. In children, the pain often makes them hold on to their faeces. This may lead to a vicious circle, as then even larger and harder faeces form, which cause more pain when they are finally passed. Therefore, in addition to the above measures, a short course of laxatives may be prescribed for children with an anal fissure. The aim is to make sure their faeces are soft and loose whilst the fissure heals.

What does a surgical approach involve?

Before a surgical approach is considered, your doctor will re-examine you and may conduct other tests to determine why other treatments have failed to heal the fissure.

Some of the reasons why a fissure may fail to heal include scarring or muscle spasms of the internal anal sphincter muscle. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle. By doing this, pain and spasms are decreased, which allows the fissure to heal. Cutting the muscle rarely results in the loss of ability to control bowel movements. The surgery can usually be performed without an overnight stay. Pain is relieved after a few days and complete healing is achieved in a few weeks.

Prevention for Anal Fissures

You may be able to prevent an anal fissure by taking measures to prevent constipation. Eat high-fiber foods, drink fluids and exercise regularly to keep from having to strain during bowel movements.

Drink plenty of water to help soften stools.

Consider using a fibre supplement (such as Metamucil).

Make sure to wipe gently after going to the toilet.

Lifestyle and home remedies for Anal Fissures

Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences:

  • See your chemist for advice on ointments specific for anal pain.
  • Take regular sitz (salt bath) baths, which involves sitting in a shallow bath of warm water for around 20 minutes.
  • Use baby wipes instead of toilet paper.
  • Shower or bathe after every bowel motion.
  • Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually.
  • Drink adequate fluids. Fluids help prevent constipation.
  • Promptly treat all occurrences of constipation and diarrhea
  • Avoid irritating the rectum
  • Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure.
  • Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.
If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your infant's doctor.

Will Anal Fissures happen again?

Some people seem prone to recurring anal fissures. Up to half of people who have a chronic anal fissure successfully treated with GTN ointment will have one or more recurrences at some time in the future. It is thought that these people have an ongoing higher than average pressure (tone) of the muscle around the anus. They are more likely to tear the rim of the anus if it is stretched. However, a further course of GTN ointment can be used to help to heal any future fissure. Surgery may be an option if you have frequent recurrences.