Anal Fissure

What is anal fissure?

An anal fissure is a small tear in the lining of the anal canal, or more simply, the skin around the anus. The anal canal is the lowest part of the large intestine. An anal fissure may occur when you place excessive strain to excrete hard or large stools during bowel movement. You are likely to experience pain and bleeding with subsequent bowel movements.

What causes it?

Anal fissures are most commonly caused by damage to the lining of your anus or anal canal.It often occurs in people who have frequent constipation, where a particularly hard or large stool tears the lining of the anal canal.

Who gets anal fissure?

It can occur in people across all ages. Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. Women who are pregnant or have recently given birth are at higher risk for anal fissures due to straining during delivery.

People with Inflammatory Bowel Disease (IBD), such as Crohn’s disease, have an increased risk of developing anal fissures as well. The inflammation in the intestinal lining makes the tissue around the anus tear more easily. People who frequently constipate have higher risk of anal fissures as well. Passing large,hard stools and straining during bowel movement are the most common causes of anal fissures.Occasionally, a sexually transmitted infection such as herpes or syphilis can infect and damage the anal canal. This results in anal fissure.

How do I know if I have it?

Symptoms of anal fissure include:

  • Pain, which may be sharp or acute, during bowel movements. This pain may last up to several hours.
  • Bleeding bright red blood on toilet paper or in the toilet bowl
  • A visible tear in the skin near the anus
  • Irritation or itchiness around the anus
  • A lump on the skin around the anal fissure
  • Spasms in your anal sphincter, the ring of muscle at the bottom of your anus

Do consult your doctor immediately should you have pain during bowel movements or observe blood during bowel movements.
How is anal fissure diagnosed?

Your doctor will diagnose an anal fissure in a physical examination for you. This involves checking for the typical symptoms and by examining the skin around your anus. The doctor may insert an anoscope into your rectum to make it easier to see the tear. Inspection of the anal canal through this thin tube may also help your doctor find other causes of anal or rectal pain such as hemorrhoids. In certain cases, you may need a colonoscopy for better evaluation of your symptoms.

Do I have to undergo surgery for anal fissure?

For most people, anal fissure usually takes 1 to 2 weeks to heal. However, in cases where the anal fissure does not heal or persistently returns, you may need to undergo surgery.

Surgery is recommended for chronic anal fissure. This is especially if other treatments such as changing your diet and using laxatives fail to work. Lateral Internal Sphincterotomy (LIS) is generally considered to be the most effective treatment for anal fissures, with more than 90 per cent of people experiencing good results in the long run.

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