An anal fissure is a small tear in the lining of the skin around the anus.
They are typically caused by constipation when hard stools pass the anus leading to a tear along the skin.
One of the most common symptoms of an anal fissure is rectal bleeding.
When left untreated, anal fissures can lead to the development of anal fistulas or even lead to the narrowing of the anal canal.
For most people, anal fissures usually take one to two weeks to heal. However, when the anal fissure does not heal or persistently returns, you may need to undergo surgery.
“An anal fissure is a small tear in the lining of the anal canal, or more simply, the skin around the anus.” – Dr Ganesh Ramalingam
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. As a result, you are likely to experience pain and bleeding with subsequent bowel movements.
The split in the skin may lead to severe pain and rectal bleeding during and after bowel movements.
While it is usually not a serious condition, anal fissures can affect people of all ages who experience constipation. They are more likely to experience a tear in the anal canal during bowel movement.
In most cases, the tear heals on its own within four to six weeks. However, 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 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. Additionally, pregnant women 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, also have an increased risk of developing anal fissures. This is because the inflammation in the intestinal lining makes the tissue around the anus tear more easily.
People who frequently experience constipation have a higher risk of anal fissures as well. Passing large, hard stools and straining during a 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, resulting in an anal fissure.
What Are the Symptoms or Warning Signs if I Have 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 (anal or rectal bleeding).
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 our 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.
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 site clean (avoid sensitive soaps 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?
Our doctor will diagnose an anal fissure through a physical examination. This involves checking for the typical symptoms and examining the skin around your anus. Next, an anoscope will be inserted into your rectum to make it easier to see the tear. Inspection of the anal canal through this thin tube may also help our doctor find other causes of anal or rectal pain, such as haemorrhoids.
In some instances, you may need a colonoscopy for 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 fissures (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 treatment. However, certain remedies do help 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
At times, she experienced a sensation of incomplete evacuation and used her fingers to remove the stool manually. In addition, she reported difficulty with urination and intermittent incontinence.
By understanding the conditions, her doctors were able to quickly diagnose and subsequently treat her without surgery.
Should your anal fissure not respond to other treatments, our doctor may recommend an anal sphincterotomy. This surgical procedure involves making 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, an anal fissure usually takes one to two weeks to heal. However, when 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. A 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.
I had to undergo an emergency surgery because the abscess on my bum was getting pretty bad. Dr Ganesh was detailed and wasted no time in treating me as I was in a lot of pain and honestly, I could feel pus coming out and it’s just disgusting, I just wanted it treated.
Dr Ganesh helped me get the abscess cleaned and drained and gave me some medication to recover at home. So far, I have been feeling much better and he did a great job so there was no scars or major pain.
Thank you Dr Ganesh.
5
I had severe food poisoning which resulted in a split in the skin near my buttocks. I was so shocked when I saw blood in the toilet thinking it was some terminal illness. Thankfully, after seeing Dr Ganesh, he diagnosed that I have an anal fissure and it can be treated quite easily.
I followed his advice to clean and improve my diet and within 2 weeks, I have fully recovered. Thank you Dr Ganesh!
5 Stars
Dr Ganesh is a trustworthy and caring doctor. I was hesitant at first to be seen as I noticed there was swelling and pus near my anus and wasn’t sure what to do. When I finally had to see a doctor, I found him online and I can see why people say he is friendly and patient. He managed to explain how I can get my condition treated without being difficult to understand. I followed his advice and got him to treat me, it was surprisingly not as painful as imagined and he got the pus drained. Thank you to Nurse Jiaxin for helping to clean my wound as well.
Truly a great team and clinic!
5 Stars
I had a great experience with G&L Clinic. Dr Ganesh is professional and detailed in explaining to me about my condition, anal fistula. Apparently I had it without knowing until the pain was unbearable.
Because it was much more serious, I had to undergo a minor surgery for it. But following his advice, I am able to recover ahead of the time and am already back at work.
Thank you to Dr Ganesh, Lisa, Jiaxin, Ann and Angeline for being a wonderful, efficient team!
5 Stars
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Dr. Ganesh Ramalingam
Specialist in General Surgery
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