Anal Fissure is a medical condition wherein a small tear occurs in the skin of the anus. The tear is usually about 1 cm and causes pain. Bleeding can also occur while passing motions. In normal cases, no treatment is required as the tear usually heals itself within 1-2 weeks. Anal fissures can occur at any age, but are extremely common in young infants. The fissure can be acute or chronic.
What are the signs and symptoms?
Signs and symptoms of anal fissures include:
- Sharp, stinging pain during bowel movements which may last for several hours.
- Blood streaking the stools.
- Itching around the anus.
- Frequent urination or inability to urinate
- Malodorous discharge
What are the causes?
Anal fissures may be a condition by itself or may be associated with another disorder, such as ulcerative colitis or Crohn’s disease. Other causes include:
- Injury to the anal canal. The injury can be caused due to the following reasons:
- Repeated diarrhoea
- Constipation and trying to pass a hard stool.
- Passing of a large stool that stretches the anal canal.
- Anal intercourse
- Insertion of foreign bodies for examination purposes.
- In some people there is excessive tension in the two muscular rings controlling the anus. Due to the acute pressure, spasm is cause and blood flow to the anus is reduced causing anal fissure. Due to the excessive pressure, it prevents the fissure from healing also.
When to seek medical advice?
You should seek immediate medical advice:
- Even after taking home treatment, your anal fissure has not healed after 6 weeks.
- Rectal bleeding.
What are the methods for screening and diagnosis?
Methods for diagnosis of anal fissures include:
- Fissures are diagnosed by a visual examination of the anus or by a rectal exam.
- A proctoscope or sigmoidoscope (thin tube attached with a lighted camera) may be used to examine the rectum and end of the colon.
- Alternatively, the doctor will perform a digital rectal examination or an anoscope to examine the fissure. If the fissure is very painful, the doctor usually waits for the fissure to heal before conducting any examination to rule out any other problems. If examination has to be conducted immediately on the fissure, topical anaesthesia is used.
What is the treatment?
The primary aim of treatment is to reduce pressure on the anal canal by softening stools, and reducing discomfort and bleeding.
- Improved Diet:Most anal fissures can be treated at home by taking a high fiber diet along with lots of liquids.
- Home Treatments: You can also soak yourself in a shallow warm water bath every day at least 2-3 times. You can apply some cream or ointment that contains an anaesthetic to help ease the pain. Some fissures heal without any treatment.
- Prescribed Medicines: You can also take prescribed medicines if the fissure lasts for a long time. Applying glyceryltrinitrate (GTN) ointment to the anus is one way to treat anal fissure. The ointment relaxes the muscles around the anus, thus allowing the fissure to heal faster. But the dosage for the ointment should be as prescribed by your doctor.
If the fissure still persists even after medication, surgery might have to be considered. The most common surgery is lateral internal sphincterotmy. Here, the doctor cuts into part of the internal sphincter (one of the muscular rings controlling the anus) to relax the spasm causing the fissure.
How to prevent?
You can follow few tips to prevent anal fissures:
- Have a high fiber diet.
- Drink lots of fluid.
This will prevent constipation, hence resulting in normal bowel movements.
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