Anal Fissures: Symptoms, Causes, Diagnosis & Treatments

An Anal Fissure is a minute opening or a cut on the wall of an anus. The cut on the wall causes sharp pain resulting in bleeding during and after the faeces discharge. Sometimes, the opening can be profound, which might reveal the muscle tissues beneath.

The major causes of anal fissures are strained faeces discharge, an extended period of constipation, childbirth. An anal fissure can also occur due to specific medical ailments like infection, inflammatory bowel disorder, and cancer. The problem of anal fissure can be observed in people of all age groups, and it is very often found in infants or young children. Usually, it is not a significant condition, and the opening can heal itself within four to six weeks. But in some cases, fissures may prolong for more than six weeks where it becomes a necessity to take doctor’s advice on the issue.

The issue is then considered as a chronic disease. There are specific treatments, which can help its healing and can provide comfort. The treatments include faeces softners and insular pain reliever. If the problem persists and the procedures as mentioned earlier do not help, surgery may be required.

Causes of Anal Fissures:

The anal canal is merely around 1-2 inches in length and exits the body from the last part of the large intestine. Two orbicular muscles control the bowel movement of the body. The internal sphincter in anal helps prevent leaking of stool through its contraction. The external sphincter in anal is a spontaneous muscle. As the fissure is a trauma to the anal canal, it usually occurs during constipation or difficult faecal movement. It is very often to remember the origin of the faecal discharge pain during such incidence.

The anal fissure has two types:

Chronic and Acute

An acute anal fissure is a cut or opening on the surface of the skin; whereas a Chronic anal fissure is developed over time if the acute fissure retaliates healing. The cut may penetrate deep into the tissue lining the muscles of an inner sphincter.

The most often cause of occurring anal fissure is the discharge of hard and large stool. Prolonged constipation and periodical diarrhoea may also be the causes of cuts or openings in and around the anal canal.

Apart from these cases, the others include:

  • IBD or Crohn's Disease
  • Stretch while giving birth
  • A reduced flow of blood into the anorectal area
  • Overtight sphincter muscle

While these can cause anal fissures there are also some rare cases where an anal fissure is likely to occur:

  • HIV
  • Herpes
  • Tuberculosis

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Symptoms of Anal Fissures:

The basic indication of an anal fissure is the pain during faecal discharge and its persistence.

The vile circle of obstipation makes the sphincter muscles go into contraction causing severe pain , which persists over time. The pain can be of a significant amount, which makes sitting harder and more painful including the bowel movement. You may find some drops during wiping or into the pot while discharging. There are cases when bleeding does not occur along with the severe pain.

An anal fissure may have more than one symptom, and they are:

  • An evident cut surrounding anus skin
  • A minute lump near the cut
  • Severe pain during fecal discharge
  • Bleeding during the discharge or while wiping
  • Burning sensations in and around anal

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Some risk Factors of Anal Fissures:

It is very often to find anal fissures in particular kind of people. Anal fissures have some risk factors for the following people during a specific condition:

  • It is very common while the child is still an infant.
  • People ageing over 60 have the higher risks of having anal fissure due to reduced blood flow through their anorectal area.
  • Women in their pre and post pregnancy are often diagnosed with an anal fissure due to the irregular pattern of faecal discharge and strain during labour.
  • People suffering from IBD (Inflammatory Bowel Disorder) are often observed having anal fissure issues. The inflammation during bowel discharge causes the tissues prone to tearing, resulting in blood loss, sometimes.
  • People who have periodic constipation are at a higher risk of anal fissure diagnosis than any other person. It usually consists of the hard and large passage of stool, which may cause discomfort in the anal canal and result in fissures.

Diagnosis of Anal Fissure:

The routine procedure doctor follows to diagnose an anal fissure is examining the anus area. Despite the general examination they, sometimes, may conduct a rectal exam to get the confirmation.

The process of the rectal exam starts with the insertion of an anoscope into the rectum of the patient , which helps in making the tear visible. A rectal exam is an important test as it confirms the type of disease. If there is a rectal pain, the doctor will perform an endoscopy to get better results of evolution and its symptoms.

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Treatment of Anal Fissures:

Mostly, an anal fissure does not have lengthy treatments. Acute fissures can be treated at home with utmost precautions. The home remedies , which promote pain relief include:

  • More liquid intake
  • Consuming fibrous food like vegetables and raw fruits
  • Taking fibre supplements
  • Prefer a warm bath to relax anal muscles and enhanced blood flow through anorectal
  • Apply modern pain relievers (like lidocaine) to the anus and its surrounding for easing discomfort

If the symptoms do not vanish within two weeks of the home treatment, consult a medical practitioner at the earliest. Further treatment can be taken under the observation by an experienced medical practitioner.

Sometimes, Botox injections are also advised by doctors. The dose prevents contraction in the anus transitory paralyzing the anus muscles. The process allows the present anal fissures to heal and prevents the formation of new cracks.

There are very few cases when the aforementioned treatments do not give the required results. In that case, the doctor may advise an anal sphincterotomy. It is a surgical procedure, which includes creating a tiny incision in your anal sphincter to ease the tissues. The incision allows the anal fissure to recover. It is only considered in the rare cases where all other medications fail to show any progress. The patient can regain a normal living after 2-3 days of the surgery.

Remember, not all fissures occur due to less fibre consumption and periodical constipation. There can be several other reasons. If home remedied do not work for at least two weeks, it is advisable to check with an experienced doctor of the concerned field.

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Anal Fissures Medications:

For most of the time, it is seen that the improvements have been made with the home remedies. But, in some cases, the home remedies might not work, so the treatment is moved to modern medications.

The treatment of anal fissures has discrete categories of medications. They are:

  • Fibre supplement
  • Constipation controlling medication
  • Faecal discharge softener
  • Modern Medicines
  • Sphincter Muscle or Tissue Contraction Control
  • Botox injections or steroids (only considered in case of intractable pain)

Prevention from Anal Fissures:

Anal fissure can’t be prevented easily. However, its risk can be reduced significantly.

The prevention includes various guidelines , which can be followed routinely.

  • Keep the anal area clean and dry.
  • Gently cleaning the outside anus area with warm water and moderate soap
  • Drink lots of water and other liquids
  • Eat Fiber-rich food and practice regular exercise
  • Treat diarrhoea with immediate effect
  • Change the diapers of infants frequently and avoid rashes.

Myths And Rumors Related to Anal Fissures :

There are various myths and rumours about anal fissures, which often lead people towards the wrong direction and can worsen the situation for them. Enlisted below are few of them:

1. The primary myth is that the anal sphincterotomy (surgery) is a painful procedure.

The notion is utterly false as it is just like every other surgery where anesthesia is given to patients before operating. Also, with the success rate of over 95%, the patient can lead a healthy life after 2-3 days of the surgery.

2. Anal fissures are unrestrained.

The people having least know-how only spread the myth. People who have undergone surgery never experienced it again. If the disease is inconsistent, people would never have preferred operation for the sake of having the disease again.

3. Rumors about surgery not being a permanent cure.

The rumor is blatantly false as it is a permanent cure. The experienced medical practitioners only carry the procedure, hence, after the internal anal sphincterotomy; it becomes impracticable to grow a chronic fissure.

Patients are often seen mixing anal fissures with hemorrhoids, so, it is very advisable for all to visit a doctor for a proper examination of the disease and then to follow his prescribed medications. Fissures require specific treatment and should always be treated appropriately. Also, when the patient does not respond positively to the prescribed medications, doctors may advise performing a surgery. The procedure is a very delicate process, but not risky. The surgery has a success rate of over 95%. The patient remains admitted in the hospitals only for a few hours or a day. Before operating, local anesthesia along with other sedation is given to the patient. After its success, the patient may not tend to develop the chronic disease again.

Frequently Asked Questions (FAQs)

1).  What is the reason for getting anal fissures?

Ans: There can be numerous reasons for anal fissures. They are caused by a trauma, which stretches the anal beyond its break point. Some of many reasons are Constipation, childbirth, diarrhea, and more.

It is not very often but can be seen the anal fissures due to hard anal sex without lubrication, putting objects into the anal canal causing extended stretch. Another reason includes high pressure during a bowel movement, contracted anal sphincter tissues, and low blood supply to the anus.

2). What can be the possible initial treatments?

Ans: There are some home remedies, which should be practiced before visiting a doctor. They consist of warm baths, high liquid intake, massages, and applying anesthetic creams during the night.

3). What should be done if it pains during the night and the possibility of rushing to a doctor is very less?

Ans: In this case, first, take a warm bath and clean your anus area with warm water for as long as you can and feel little better. After this, apply an anesthetic cream gently over your anus and its surrounding area. You can also use a natural ointment such as Dr. Numb or go for a new tube carrying lidocaine. It will ease the pain, and then you can visit the doctor as soon as possible.

4). Can I use steroids in case of an emergency?

Ans: Please read the answer as mentioned earlier. In case the pain still persists, it is only advisable to visit the doctor and take recommendation before using any. After consulting at least once, you can take them the second or third time the pain occurs. Even in the worst cases, the duration of use should not be long enough.

5). I am using a laxative for my anal fissures. Is it still advisable to take homeopathy medicines?

Ans: It is the most commonly asked question from doctors , and the answer is yes, you can.

6). Will the problem persist after homeopathy medication?

Ans: There are fewer chances of this happening. But, the future may only be dependent on your diet and consumption of liquids. It also depends on the care of your anal area.

7). Why the wound does not heal on its own

Ans: If the abrasion due to hard stool is extreme and deep into the tissue, the wounds fail to recover on its own. The injury traps some stool and its bacteria. As the cleanliness of the inner portion is not possible, the wound gets only worse and not heal at all.

8). Which type of foods is preferred during anal fissure?

Ans: The foods having rich fiber are the best for fissure patients such as raw fruits, vegetables (especially leafy and green), oatmeal, brown rice, beans, cereals, bread, wheat bran, whole-grain pasta, peas, and foods alike.

Anal fissures are not generally severe problems, and they definitely don't cause cancer. But their presence can become very uncomforting and can result into some swelling of the anal area and in some cases bleeding.

To keep fissures far from you keep your diet as healthy and fiber & vitamin-rich, clean yourself often with warm water and always stay hydrated.

Just by following these points, anal fissures will never be in your range.

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Last updated on : 24-12-2018

Disclaimer : Docprime doesn’t endorse or take any guarantee of the accuracy or completeness of information provided under this article and these are the views strictly of the writer. Docprime shall not be held responsible for any aspect of healthcare services administered with the information provided on this article.

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