Anal Fissure

Causes of Anal Fissures

The main causes of anal fissures include:

• Hard or large stools: Straining to pass hard stools can stretch and tear the skin in the anus.
• Chronic constipation or diarrhea: Both conditions can cause repeated irritation and damage to the anal skin.
• Childbirth: Vaginal delivery can cause trauma to the perineum (the area between the anus and vagina), leading to fissures.
• Anal intercourse: This can cause direct trauma to the sensitive tissue of the anal canal.
• Other causes: In some cases, conditions such as inflammatory bowel disease (IBD), including Crohn’s disease, or infections like syphilis and tuberculosis can contribute to the development of anal fissures.

Symptoms of Anal Fissures

• Pain: A sharp, burning pain during or after bowel movements, often lasting several minutes or hours.
• Bleeding: Small amounts of bright red blood on the toilet paper or in the toilet bowl after a bowel movement.
• Itching: Around the anus due to irritation from the fissure.
• Visible Tear: A visible tear or crack in the skin around the anus, sometimes accompanied by swelling or a small lump (sentinel pile) near the fissure.
• Spasm: Muscle spasms in the anal sphincter, which can increase pain and make the fissure worse.

Types of Anal Fissures

1. Acute Anal Fissures:
   • These are recent tears, usually less than 6 weeks old.
   • They typically heal on their own with conservative treatment.
2. Chronic Anal Fissures:
   • These are fissures that persist for more than 6 weeks or keep recurring.
   • Chronic fissures may become deeper and cause complications like scarring and the formation of a sentinel pile (a swollen skin tag near the fissure).
   • In some cases, the anal sphincter muscle may spasm and prevent proper healing.

Diagnosis

Diagnosis of an anal fissure is usually based on a physical examination. A healthcare provider will look for a visible tear or crack around the anus. In some cases, additional tests may be needed:

• Anoscopy: A small, lighted tube may be inserted into the anus to view the internal area for deeper fissures or other issues.
• Biopsy: In rare cases, a biopsy might be performed if the fissure is suspected to be related to an underlying condition (like Crohn’s disease or cancer).

Treatment for Anal Fissures

Treatment usually aims to relieve pain, promote healing, and prevent recurrence. Treatment options can be divided into conservative (non-surgical) and surgical approaches.

1. Conservative Treatments:

• Fiber-rich diet: Increasing fiber intake through foods (fruits, vegetables, whole grains) or fiber supplements can help soften stools and reduce straining.
• Adequate hydration: Drinking plenty of fluids helps prevent constipation.
• Stool softeners: Over-the-counter stool softeners can reduce the need for straining during bowel movements.
• Topical treatments:
  • Numbing creams: Over-the-counter or prescription creams with local anesthetics (like lidocaine) can numb the area and reduce pain.
  • Nitroglycerin ointment: A common prescription treatment that helps relax the anal sphincter muscle, reducing pain and promoting blood flow to the area for faster healing.
  • Calcium channel blockers: Topical creams containing nifedipine or diltiazem are also used to relax the anal sphincter and aid healing.
• Warm baths (Sitz baths): Sitting in warm water for 10-15 minutes several times a day, especially after bowel movements, can help relieve pain, reduce muscle spasms, and promote healing.
• Avoiding straining: Using the bathroom as soon as you feel the urge to go and avoiding prolonged sitting on the toilet helps prevent further irritation.

2. Surgical Treatments (For Chronic Fissures or Severe Cases):

• Lateral Internal Sphincterotomy: This procedure involves cutting a small portion of the anal sphincter muscle to relieve spasms and promote healing. It is highly effective but carries a small risk of incontinence.
• Fissurectomy: In some cases, a fissure may be removed surgically if it’s not healing with conservative methods.
• Botox Injections: Botulinum toxin (Botox) may be injected into the anal sphincter to temporarily paralyze the muscle and relieve spasms, promoting healing.

Prevention

To prevent anal fissures, it’s important to:

• Eat a high-fiber diet: This helps avoid constipation and hard stools, reducing the risk of injury to the anus.
• Stay hydrated: Drink plenty of water to keep stools soft.
• Avoid straining: Don’t hold your breath or push too hard during bowel movements.
• Use the bathroom promptly: Don’t ignore the urge to have a bowel movement, as holding it in can lead to harder stools.
• Practice good hygiene: Gently clean the area around the anus after bowel movements, but avoid excessive wiping or harsh cleaning, which can irritate the skin.

When to See a Doctor

• If you experience severe pain during or after bowel movements.
• If there is persistent bleeding from the anus.
• If your symptoms last longer than a few weeks, especially if they don’t improve with over-the-counter treatments.
• If you suspect the fissure is caused by an underlying condition, such as inflammatory bowel disease or an infection.

Conclusion

Anal fissures are common, and while they can be very painful, they are usually treatable with conservative methods. If left untreated or in more severe cases, they can lead to chronic issues, so it’s important to seek appropriate medical care if needed. If you experience ongoing pain or bleeding, or if home treatments aren’t working, it’s best to consult a healthcare provider for further evaluation and treatment.