Anal Fissure

An anal fissure is a tear in the tissue of anus. The anus is the last part of digestive tract. It’s at the end of rectum. It has a ring of muscle (sphincter) that opens during a bowel movement to allow stool (feces) to pass through. A fissure is caused by the anal tissue stretching too much. This can happen during a hard bowel movement. It Causes pain and bleeding.

Anal fissures are not the same as hemorrhoids. But the Symptoms can be similar. Hemorrhoids are inflamed blood vessels in or just outside the anus. An anal fissure is one of the most common non-cancer (benign) conditions of the anus and rectum.

The most common cause is large or hard stools because of constipation. A fissure may also be caused by severe diarrhea, anal sex, vaginal childbirth, or an object inserted into the anus.

A person is more at Risk for an anal fissure if they have any of the below:

  • Constipation that makes  strain to pass hard stool
  • A low-fiber diet
  • A lot of diarrhea
  • Recent weight loss surgery, if it leads to frequent diarrhea
  • Vaginal childbirth
  • Minor injury, such as from mountain biking
  • Any inflammatory condition of the anal area
  • Inflammatory bowel disease
  • Infection or HIV
  • Surgery
  • Other medical Treatments that affect bowel movements or the anus

An anal fissure is one of the most common Causes of anal pain and bleeding. Symptoms can occur a bit differently in each person.

They can include:

  • Pain during and after a bowel movement that can last for hours
  • Visible tear or cut in the area
  • Bright red bleeding during or after a bowel movement

The Symptoms of an anal fissure may be like other health conditions.

Pain from the fissure can cause muscle spasm in the anal sphincter muscle. This can make it hard for the fissure to heal. The spasm can also cause more tearing during bowel movements. This cycle can lead to a chronic anal fissure in many people.

Other Complications can include:

  • Ongoing pain and discomfort
  • Trouble having bowel movements
  • Not having bowel movements because of the pain
  • Reduced quality of life
  • The fissure coming back after Treatment
  • Pus-filled infection (abscess)
  • Uncontrolled bowel movements and gas

 

How is it diagnosed?

Tests may include:

 Symptoms and health history and physical exam. The physical exam will include anal area. Gently separate buttock and look at the area around the anus for a tear and other signs of a fissure. Where the fissure is may help find the cause. Fissures most often occur in the back center of the anus. Some occur in the front center of the anus. Fissures that occur on the sides of the anus may be caused by conditions such as Crohn’s disease.

  • Digital rectal exam.  Gloved, lubricated finger gently inserted into anus. A tool called a speculum may also be used. It is put into the anus and gently expanded. This allows to see more of the anal area.
  • Fecal occult blood test. This test checks for hidden blood in stool. May do a colonoscopy or sigmoidoscopy.

How is it treated?

Treatment will depend on Symptoms, age, and general health. It will also depend on how severe the condition is.

An acute anal fissure is one that lasts for a short time. It often heals within 6 weeks with simple Treatment. It may heal when constipation is treated.

A chronic anal fissure is one that lasts for 6 weeks or more. This may need more Treatment, such as surgery.

If anal fissure doesn’t heal well, it may be a problem with anal pressure because of the sphincter muscle. This prevents blood from flowing normally through the blood vessels in the anus. The reduced blood flow prevents healing. Treatment may include medicine to put on the fissure and botulinum toxin shots (injections). These can help with blood flow and may help an anal fissure heal.

Other Treatments include:

  • Changes in diet.  Eat more fiber and drink more water to help ease diarrhea or constipation. It’s very important to treat constipation, or the fissure is likely to come back.  Getting enough fiber will help prevent constipation and large or hard bowel movements.
  • Sitz baths. Sitting in a warm, shallow bath for up to 20 minutes a day can help ease Symptoms.
  • Stool softeners. Medicines to soften stool or fiber supplements may help ease constipation.
  • Other medicines. Cream, ointment, or suppository medicines such as nitrates or calcium blockers may help heal the fissure.
  • Surgery. The surgery is called lateral internal sphincterotomy. During the surgery, a small cut (incision) in the muscle helps release the pressure inside the anus. This lets more blood flow through the area to heal tissues.

Consult with experienced Doctors

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