An anal fissure is a tear in the lining of the anus or anal canal, causing pain and potential bleeding during bowel movements. While anyone can develop anal fissures, the likelihood decreases with age, and individuals with a history of fissures are more prone to experiencing them again.
Anal Fissure is a longitudinal tear in the lower end of the anus. It is the most painful condition affecting the anal region. It is commonly seen in young patients.
Causes of Anal Fissures:
– Trauma to the anus and anal canal, often associated with:
– Chronic constipation
– Straining during bowel movements, especially with large, hard, or dry stools
– Prolonged diarrhea
– Anal sex or stretching
– Insertion of foreign objects into the anus
– Other causes include poor bowel habits, overly tight anal sphincter muscles, scarring in the anorectal area, underlying medical conditions (such as Crohn’s disease, ulcerative colitis, anal cancer, leukemia, infectious diseases, and sexually transmitted infections), and decreased blood flow to the anorectal area.
– Common in young infants and women after childbirth.
Signs and Symptoms of Anal Fissures:
– Pain during and after bowel movements.
– Constipation.
– Blood on the surface of the stool.
– Blood on toilet tissue or wipes.
– Visible crack or tear in the anus or anal canal.
– Burning and itching, which may be painful.
– Discomfort during urination, frequent urination, or inability to urinate.
– Foul-smelling discharge.
Treatment of Anal Fissures:
1. Conservative measures:
– Preventing constipation through stool softeners, increased fluid intake, and dietary adjustments.
– Warm baths (sitz baths) several times a day.
– Gentle cleansing of the anorectal area.
– Avoiding straining and prolonged sitting on the toilet.
– Use of petroleum jelly for lubrication.
2. If conservative treatments fail:
– Hydrocortisone-containing suppositories, foams, or creams to reduce inflammation.
– Other creams and ointments, including medicated cream, topical muscle relaxant, anesthetic ointment, or nitroglycerin or calcium channel blocker ointments.
– Injection of botulinum toxin type A (Botox) into the anal sphincter to relieve pain and promote healing.
3. Surgery:
– Considered if conservative measures and medical treatments are unsuccessful.
– Involves making a cut to a small portion of the internal anal sphincter muscle to reduce pain, muscle spasms, and facilitate healing.
– Usually performed on an outpatient basis with minimal impact on bowel control.
Before surgery, a thorough examination and additional tests are conducted to understand why other treatments have failed. Surgery aims to address scarring or muscle spasms hindering the healing of the fissure. Pain relief occurs within a few days, and complete healing typically takes a few weeks.