Anal Fissures

An anal fissure is a tear or crack in the lining of the anus. It is one of the most common causes of pain during defecation and rectal bleeding and commonly affects young infants and pregnant women. 

What is an Anal Fissure?

An anal fissure is a small tear or cut in the lining of the anus. This tear leads to pain and bleeding with the passage of stool. In many cases, it is because of constipation or difficulty passing hard stools. This condition can be acute or chronic, but most cases improve with simple measures like increased fiber intake or soaking in warm water. In some cases, medication or surgery may be needed to treat an anal fissure.  

Symptoms of an Anal Fissure

Some common symptoms of an anal fissure include:

• Pain during bowel movements 
• Bright red blood on the stool 
• Itching or irritation around the anus 
• Pain that may last for several hours following bowel motions.
• Noticeable crack in the skin at the anus.
• Skin tag or little lump on the area of skin next to the anal fissure.

Anal Fissures Causes

Several factors contribute to the development of anal fissures:

• Straining during bowel motions might damage the sensitive anal tissue.
• Passing hard or large stools 
• Chronic diarrhea 
• Childbirth 
• Anal intercourse 

Less prevalent causes of anal fissures are:

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

Diagnosis

In addition to reviewing your medical history, your doctor will probably do a physical examination that includes careful inspection of your anal area. In order to determine whether you have an underlying problem, your provider can advise more tests. Tests might consist of:

• Anoscopy or sigmoidoscopy: A small, lighted tube is used in these procedures to examine the anus and rectum closely. 
• Colonoscopy: A flexible tube is inserted into your rectum to look at your whole colon during this procedure.

Anal Fissure Treatment

Anal fissures may commonly heal at home in a matter of weeks with the right care. Increasing fiber intake can help soften stools and prevent constipation, which can help reduce the risk of anal fissures.  If your symptoms don't go away with natural remedies for anal fissure, you'll probably require more care. The degree and persistence of symptoms determine the course of treatment for anal fissures:

• Topical medications: Application of creams or ointments to relax the anal sphincter and promote healing.
• Botulinum toxin injection: This can help relax the anal sphincter muscle.
• Blood pressure medicines: Medications that lower blood pressure and relax the anal sphincter.  
• Surgery: In severe cases or chronic fissures, surgical intervention may be necessary to repair the tear.

Risk Factors

Certain factors increase the risk of developing anal fissures:

• Chronic constipation or diarrhea
• Low fiber diet
• Obesity
• Childbirth 
• Age (young infants and older adults are more susceptible)
• Inflammatory bowel disease, Crohn's disease or ulcerative colitis

Complications

Complications of untreated anal fissures may include:

• Chronic pain
• Recurrence. 
• Formation of a chronic anal fissure
• Infection
• Abscess or fistula formation
• A tear that reaches the nearby muscles

Addressing these complications promptly is essential to prevent further health issues.

When to See a Doctor

It's important to seek medical attention if:

• Pain and bleeding do not go away with home remedies.
• You notice signs of infection (increased pain, swelling, discharge)
• You have recurrent anal fissures

Home Remedies for Anal Fissure

For anal fistula home treatment, some effective home remedies include:

• Increasing fiber intake in your diet
• Stool softeners: Over-the-counter medications can help soften stools.
• Drinking plenty of water to maintain soft stools.
• Soaking in warm water for 10-15 minutes several times a day.
• Having bowel motions without exerting yourself. 

While these home remedies can be effective, it's important to consult a healthcare provider for persistent symptoms.

How to Prevent an Anal Fissure

Anal fissure prevention approaches may include:

• Maintain a high-fiber diet
• Stay hydrated 
• Regular Exercise
• Practice good anal hygiene

Conclusion

Anal fissures are quite common and they are usually not serious. However, they can be quite painful. But they are in most cases preventable and manageable with some changes in diet, medication, and at times, medical procedures. It is advisable to consult the doctor in case the symptoms last for long or there is something you regard as worth a doctor’s attention to get the right diagnosis and prescription. Understanding anal fissures can help a person make better health decisions and get timely care for this painful condition. 

FAQs

Q1. Are anal fissures common?

Ans. Yes. Anal fissures are quite common. People of all ages can get anal fissures, even children at a tender age and elderly persons. Even though they are associated with constipation and straining while passing a bowel movement, they may also occur due to other reasons and are a primary source of pain and discomfort in the anus region.

Q2. How long can an anal fissure last?

Ans. An acute anal fissure does not last for more than two to four weeks if adequately managed. If it lasts longer than six weeks, it can be considered as ‘‘chronic’’ and may require more therapy or further medical intervention to heal.

Q3. Why do I keep getting anal fissures?

Ans. Constipation, diarrhea or straining during bowel movements are common causes of recurring anal fissures. Inadequate hydration, not enough fiber, and underlying medical conditions like inflammatory bowel disease can be major contributors.

Dr. Unmesh Takalkar

MS, M.E.D.S FUICC, FAIS, FIAGES, FACG, FASGE, MSSAT
United CIIGMA Hospitals (A unit of CARE Hospitals), Chh. Sambhajinagar

To Book an Appointment, call:

+91 406 810 6585