Anal Fissure: Overview
An anal fissure is a condition defined by a small tear present in the thin, wet tissue lining the anus, which is the muscle aperture at the end of the digestive system responsible for stool expulsion. Straining or large stools during bowel movements and constipation are among the most common causes of anal fissures.
Anal fissures can affect people of all ages.. Fortunately, most anal fissures can be easily treated through simple interventions such as increasing fiber intake or warm-water baths. However, in some cases, medication or surgery may be necessary to treat anal fissures.
Symptoms of Anal Fissures
Anal fissure symptoms include:
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When to see a doctor?
Consult the doctor if you have pain during bowel movements or notice blood on the stools or toilet paper after a bowel movement.
Causes of Anal Fissures
Anal fissures are commonly caused by the following factors:
The following are less common causes of anal fissures:
Risk factors
The following factors may increase the chances of having an anal fissure:
- Constipation: Tearing is increased by straining during bowel motions and passing hard stools.
- Childbirth: Women are more likely to develop anal fissures after giving birth.
- Crohn's disease: Chronic intestinal inflammation is caused by this inflammatory bowel disease. This could make the anal canal lining more prone to tears.
- Age: Anal fissures can develop at any age but are more frequent in infants and middle-aged adults.
Complications
Anal fissure complications may include:
- Failure to heal: An anal fissure that does not heal after eight weeks is considered chronic and may require additional treatment.
- Recurrence: After you've had an anal fissure, you're more prone to have another one.
- A rip that extends to the muscles around it: An anal fissure may extend into the muscular ring that keeps the anus closed. The internal anal sphincter is the name given to this muscle. If this occurs, it makes healing of the anal fissure more difficult. Unhealed fissures can set off a cycle of discomfort that may necessitate taking pain relievers or surgery to fix or remove the fissure.
Diagnosis
The doctor will most likely ask about the medical history and perform a physical exam, which will include a gentle digital examination of the anal region. The tear is frequently noticeable. This exam is usually all that is required to identify an anal fissure.
A more recent, acute anal fissure appears like a fresh rip, similar to a paper cut. A deeper tear is expected in a long-lasting, chronic anal fissure. It may also have fleshy growths on the inside or outside.
The location of the fissure provides information regarding its cause. The provider may advise patients to undergo additional tests to determine whether they have an underlying condition. The following tests may be performed:
- Anoscopy: An anoscope is a tubular device put into the anus to assist the doctor in examining the rectum and anus.
- Flexible sigmoidoscopy: The healthcare provider inserts a thin, flexible tube with a tiny camera into the sigmoid colon. If you are over 45 years and have risk factors for intestinal illnesses or colon cancer, you may be eligible for this test.
- Colonoscopy: A tube is inserted into the large intestine to check the entire colon. A colonoscopy may be performed if you:
- Have risk factors for colon cancer.
- Have other symptoms, such as abdominal pain or recurrent diarrhea.
- Are older than age 45
- Have symptoms suspicious of other serious conditions.
Treatment
With suitable home treatment, anal fissures can heal within a few weeks. Increase the intake of fiber and liquids in your diet to help keep the stool soft. Soak in warm water for 10 to 20 minutes often, especially after bowel motions. This can aid in sphincter relaxation and healing. If the symptoms persist, you will most likely require more treatment.
1. Nonsurgical treatments
The medical professional might recommend:
- Externally applied nitroglycerin (Rectiv) which may facilitate healing by boosting blood flow to the fissure. The anal sphincter can also be relaxed with its help. In cases where more conservative treatments are ineffective, nitroglycerin is usually considered the best option.
- Topical anesthetic creams like Xylocaine (lidocaine) can relieve pain associated with anal fissures.
- Onabotulinumtoxin A injection can be used to paralyze the anal sphincter muscle and reduce spasms temporarily.
2. Surgery
When other treatments fail to resolve a chronic anal fissure or if symptoms are severe, surgery may be recommended by healthcare providers. The most common surgical procedure for anal fissures is lateral internal sphincterotomy (LIS), which involves the division of the internal anal sphincter muscle. This technique has been shown to promote healing and reduce spasms and pain.
Although surgery is generally more effective than medical treatments for chronic anal fissures, there is a small risk of incontinence as a potential complication.
Anal Fissures Dos and Don’ts
Follow its do’s and don’ts to manage or minimize its symptoms.
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Anal Fissures Care at Medicover
At Medicover, patients with anal fissures can receive comprehensive and individualized care to manage their condition effectively. Depending on the severity of the fissure and the patient's overall health, the treatment plan will typically include a combination of medicines and surgical procedures.
The team of general surgeons at Medicover hospitals will work closely with patients to build an effective treatment plan personalized to their specific needs and preferences. The purpose is to give compassionate treatment and support to patients to assist them in achieving the best possible results and quality of life.
