Anal Fissures – Causes, Symptoms and Treatment

What is anal fissure?

A small tear in the inner mucosal wall of the lower anal canal is called anal fissure or fissure-in-anus. It is an oval-shaped tear usually present at the anal opening. Anal fissures cause pain as well as bleeding with bowel movements. Sometimes, the tear or ulcer can be large enough to expose the underneath muscle or tissue.

It is not necessarily a disease of adulthood; it is common in infants as well.

What causes anal fissures?

Several reasons can lead to the development of anal fissures such as :

1. Excessive straining while passing stool
2. Chronic constipation or recurrent diarrhea
3. Some inflammatory conditions can also lead to fissure-in-anus such as IBD (Inflammatory Bowel Disease), Crohn’s disease, etc.
4. Reduced or decreased blood supply to the anal region
5. Constricted anal sphincter muscles
6. Anal intercourse
7. Injury during childbirth
8. Carcinoma of anal region
9. Tuberculosis
10. Sexually Transmitted Diseases such as syphilis

What are the symptoms of anal fissures?

There are some signs and symptoms that you may notice that signifies you might have developed a fissure:

1. A small tear or a visible ulcer around the anal region
2. Throbbing pain around the anal region which worsen during bowel movements
3. Streaks of blood while passing stools, which are bright red. In Hemorrhoid’s, the characteristic feature of bleeding is a splash in the pan
4. Development of a skin tag or a lump of tissue around the tear
5. Itchy or burning sensation around the anal region

When should you see your doctor?

Most fissures may heal on their own after providing supportive care at home. However, if a fissure lasts for more than eight weeks, it can result in Chronic Fissures. Such an anal fissure cannot be completely cured with supportive measures only, as the fissures may get infected and can result in complications.

You should see your doctor for immediate anal fissure treatment if your pain is worsening, with difficulty in passing stool, recurrent bleeding, excessive discomfort and inability to sit or walk properly. Your doctor will perform some tests such as Anoscopy, DRE (Digital Rectal Examination), colonoscopy, etc. to rule out fissures from other conditions such as carcinoma, hemorrhoid’s, etc.

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What are the risk factors for fissures?

Some of the risks factors associated with the development of anal fissures are:

1. History of Haemorrhoids
2. Lifting heavyweights
3. Chronic constipation or recurrent diarrhea
4. Injuries ( during childbirth)

What are the complications of anal fissures?

Usually, fissures resolve on their own within a few weeks, but without proper treatment, it can lead to serious complications such as:

1. Thrombosis (blood clot)
2. Profuse bleeding
3. Prolapse of the anal canal
4. Ulceration
5. Pus formation
6. Anemia
7. Failure to heal: An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
8. Recurrence: Once you’ve experienced an anal fissure, you are prone to having another one.
9. A tear that extends to surrounding muscles.

How to Treat an Anal Fissure?

Most of the anal fissures don’t require any medical treatment. Almost 9 out of 10 fissures can heal on their own if proper supportive measures are taken for fissures.

Home treatment for Anal Fissures:

Here are some of the best tips for anal fissure treatment at home that are completely easy to try by yourself to help improve your symptoms and stop the progression of the disease:

1. The best way to resolve a fissure is to drink plenty of fluids that help in making the consistency of the stool soft, allowing to reduce strain during constipation and while passing stool, that helps in quick healing of the ulcer.
2. Sitz bath: Sitting either in a tub or a large bucket filled with warm water not only allows a fissure to heal fast but also helps to reduce pain and stops the spread of infections. You can also add 2-3 drops of betadine solution into the water that helps in healing anal fissures quickly.
3. Adding high-fiber content food products or supplements of 25-30 grams per day into your diet allows your symptoms of constipation to go away and promotes softer bowel movements.
4. Taking laxatives will help you treat constipation with soft bowel movements that helps in reducing excess strain while passing stool and promotes healing.
5. Application of mild topical anesthetic agents such as lignocaine or lidocaine for at least 3-4 times a day on the ulcer helps in relieving pain effectively. Avoid using Narcotics for pain as it promotes constipation.
6. Identify the disease that you may think is responsible for causing fissures such as Tuberculosis, STI’s, IBD, Crohn’s disease and start immediate medications, only under the guidance of a professional Physician/Doctor.

These methods can help in resolving the initial symptoms of fissures, such as pain, bleeding, constipation, etc. If you follow good regular hygiene and a diet plan, almost all fissures can be easily cured at home without having to worry about any complications.

Medication for Anal Fissures

For chronic cases, you will need to visit your doctor for proper check and medication.

Your doctor might ask you to apply topical antibiotics and analgesic ointments to relieve symptoms. Some chronic cases of anal fissures may need surgeries for removal of fissures, clots, prolapse, etc.

Frequently Asked Questions on Anal Fissures

How do you treat a fissure?

Ans. Generally, mostly anal fissures can heal itself within a few weeks. The goal of the treatment is to provide supportive care for pain, bleeding, discomfort, and to control the spread of any infection. An individual should have a regular sitz bath in hot water at least 3-4 times a day for a week. Keep the area dry and clean while maintaining proper hygiene.

Why do I keep getting anal fissures?

Ans. The fissure is generally caused by an injury or trauma to the inner lining (mucus membrane) of the anal canal. Recurrent fissures are quite common and can arise due to failure of treatment of acute fissures, any injury during childbirth, chronic diarrhea and/or persistent constipation. Any underlying inflammatory conditions such as IBD or Crohn’s disease, STI’s, Tuberculosis etc. can also cause fissures.

Can Anal fissures get infected?

Ans. Yes, when the glands and ducts of the anal canal are blocked, the chances of these fissures getting infected are very high. People suffering from STI’s, Crohn’s disease, IBD, poor anal hygiene are at extreme risk of infection. Once infected, the person may suffer from severe pain, bleeding, pus or abscess discharge, high-grade fever, shock, etc.

How do I know if I have a hemorrhoid or a fissure?

Ans. One of the most asked questions as people always confuse fissures with hemorrhoids. Hemorrhoids are swollen blood vessels that can result due to chronic constipation, whereas a fissure denotes tears and ulcers near the anal canal. Hemorrhoids are painless, whereas fissures can cause severe pain (throbbing in nature) in the anal region.

In hemorrhoids, there is generally bleeding per rectum after passing stool (splash in the pan); in fissures, there is bright-red blood after bowel movements.

Also Read About: Solitary Rectal Ulcer Syndrome

What do anal fissures look like?

Ans. There are two types of fissures, which are Acute and Chronic Fissures. Acute fissures may initially represent a fresh tear or look like a paper-cut tear. Whereas a chronic fissure has more of a deeper wound, exposing muscle or tissues.

References:

https://www.askapollo.com/physical-appointment/general-surgeon
https://www.apollohospitals.com/procedures/colonoscopy/
https://www.youtube.com/watch?v=3PD1QsCPoJQ