Anal Fissure

What Is an Anal Fissure?


“An anal fissure is a small tear in the lining of the anal canal, simply put, the skin around the anus.”

Dr Ganesh Ramalingam


The anal canal is the lowest part of the large intestine. An anal fissure may occur an excessive strain is used to excrete hard or large stools during bowel movement. You may experience pain and bleeding in subsequent bowel movements.


The split in the skin may lead to severe pain and bleeding during and after bowel movements.


As with this case of a Croatian woman, she suffered from years of pain after several botched haemorrhoid surgeries, leading to her suffering from acute anal fissure. 


While it is usually not a severe condition, anal fissures can affect people of all ages who experience constipation. They are more likely to cause a tear in the anal canal during a bowel movement. 


Typically, the tear will heal on its own within four to six weeks. Chronic anal fissures are diagnosed when the fissure persists beyond eight weeks without recovery.


What Causes an Anal Fissure?


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.


What Are the Risk Factors That Cause Anal Fissures?


Anal fissures can occur in people of 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. The inflammation in the intestinal lining makes the tissue around the anus tear more easily. 

People who frequently constipate have a higher risk of anal fissures as well. Passing large, hard stools and straining during bowel movements 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.


What Are the Symptoms or Warning Signs if I Have an Anal Fissure?

Symptoms of an 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.


While it may be tough to share about this condition, Emma Rushton of Nashville recounts the challenges she faced managing anal fissure and the difficulty in divulging her condition to others.


“Believe me, when I was struck down by mine, the last thing I wanted to do was tell people.” So, like many others, she suffered in silence.


How Can Anal Fissures Be Prevented?


While anal fissures cannot be prevented, there are preventive measures that you can take to reduce the risk of getting one. These are:


  • Maintaining a dry environment around the anal area
  • Keeping the anal area clean (avoid sensitive soups when washing)
  • Drinking plenty of fluids and staying hydrated,
  • Eating fibrous foods, 
  • Keeping active and exercising regularly,
  • Treating diarrhoea immediately,
  • Changing infants’ diapers frequently (for babies)


How Are Anal Fissures Diagnosed?


Anoscope, Anal Fistula, Anal Disease, Anal Fissure


Your doctor will diagnose an anal fissure in a physical examination for you. This involves checking for the typical symptoms and 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 haemorrhoids. 


In some instances, you may need a colonoscopy for a better evaluation of your symptoms.


What Are the Potential Complications of Anal Fissures?


While anal fissures are not associated with any serious diseases, such as bowel cancer, possible complications of an anal fissure may include:


  • Chronic anal fissure (a condition for prolonged anal fissures that do not heal after eight weeks or more)
  • Anal fistulas (a condition that causes an abnormal connection at the anal canal to other surrounding organs)
  • Anal stenosis (a condition that causes the anal canal to become abnormally narrowed)


How Are Anal Fissures Treated?


Anal fissures usually do not require extensive treatments. However, specific remedies help to relieve the symptoms while promoting healing. These are:


  • Using over-the-counter stool softeners
  • Drinking more fluids
  • Consuming enough fibrous foods, such as raw fruits and vegetables
  • Taking a sitz bath 
  • Applying topical pain relievers, such as lidocaine, to the anus to ease discomfort


A case study of a 39-year-old woman suffering from constipation and abdominal pain led to discovering the cause of her discomfort: anal fissure.


She reported experiencing a sensation of incomplete evacuation and used her fingers to remove the stool manually. Also, she complained of difficulty with urination and intermittent incontinence.


By understanding the conditions, her doctors were able to quickly diagnose and subsequently treated her without surgery. Should your anal fissure not respond to other treatments, your doctor may recommend an anal sphincterotomy. An anal sphincterotomy involves creating a small incision in the anal sphincter to relax the muscle, allowing the anal fissure to heal better.


When Should Surgery for Anal Fissures Be Considered?

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 so if other treatments such as changing your diet and using laxatives fail to work. Lateral Internal Sphincterotomy (LIS) is generally considered 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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