Anal Fissure – Cause, Symptoms and Treatment

Defining an Anal fissure 

An anal fissure is a common condition that can affect both men and women in any age group. A condition that can easily be treated at home, a fissure develops when the lining in the anus tears and causes a lot of pain when passing stool. 

Anal fissures, by themselves are not a very serious problem, and they usually heal within a few weeks. 

If your condition persists after six weeks, it is termed a chronic condition, which may require medicines and further treatment. In more serious cases, surgery is also advised. Complications may arise when you have a fissure and a hemorrhoid developing together. 

Causes of Anal Fissure 

Injury to the anal canal can lead to anal fissures. Injuries might happen as a result of:

• Passing large and/or hard stool that irritates and stretches the anal canal

• Chronic Diarrhea

• Inserting a foreign body into the anus

• Insertion of a digital object, as in a medical examination

• Anal intercourse

• Pregnancy and child birth

• Crohn’s disease (a condition that causes inflammation of the bowel and is characterized by fever, abdominal pain, bloody diarrhea, and fissures near the anus)

Some experts are of the opinion that there is more to the causes of an anal fissure than just constipation or diarrhea. They believe that constant pressure in the internal sphincter (muscular rings) that controls your anus could be a major cause of this condition. 

While the external anal sphincter can be controlled by you consciously, it is not possible to do the same for the internal anal sphincter. This muscle remains under pressure all the time and that may be responsible for the formation of fissures in the anal canal. 

Symptoms of Anal Fissure 

A sharp pain during bowel movements or a burning sensation is the primary symptom of this condition. This pain can be quite severe and can last for as long as a few hours. Patients may also feel an itching sensation.

There is also a yellow discharge or some slight bleeding. You may notice a spot of blood in the toilet bowl or on the tissue. This is not to be confused with the dark red blood that you notice on stools. They are indicators of a more serious condition, possibly inflammatory bowel disease (IBD). When you have a fissure in your anal canal, the blood will be separate from the stool you pass. 

In some cases of fissures, there is no pain. The tear in the anal canal bleeds every now and then and shows no signs of healing. But apart from this bleeding, there are no other noticeable symptoms. 

Diagnosis of Anal Fissure 

Diagnosis of this condition can be done quite easily by separating the buttocks gently and conducting an examination of the anus. The doctor has a choice of using either a gloved finger or a lighted instrument like an anoscope. 

If the patient is in a lot of pain, the physical examination may be postponed until the wound begins to show signs of healing. In some cases, a topical anesthetic may also be applied to conduct the examination immediately. 

After the examination, the doctor is usually able to ascertain what is causing the fissure and if there are any other complications involved. The presence of more than one fissure in an area of the anus where they do not commonly appear can point to conditions like syphilis, tuberculosis, IBD, anal cancer or HIV infection. 

Anal Fissure Treatment 

Fissures can usually be treated at home with remedies like a warm sitz bath several times a day, having a high fiber diet, or taking medicines that soften your stool or have a laxative effect. When treatment commences, you notice the pain will go away within a few days. The fissure itself might take a few weeks to heal completely. In a few cases, fissures might even heal themselves without the need for medical intervention. 

It is of prime importance to prevent constipation. Hard stools or constricted bowel movements can significantly slow down the healing process, and even aggravate it. Have lots of fluids and water to keep the stool soft so that it can pass through the anal canal effortlessly. 

There might be some anxiety on your part when passing motion, due to the pain you experience. However, try and relax and let the bowel movement happen naturally. If you try not to have them, they might worsen the condition. 

Non prescription ointment can soothe the anal tissues. Some such ointments are zinc oxide, Anusol, 1% hydrocortisone, or Preparation H. Before using any of these products, do consult with your doctor. And remember, since these are non prescription drugs, you should use them only for a short period of time. 

As far as prescription drugs are concerned, a doctor may advise them if you fissure lasts for a really long time. Some of the prescription drugs used are nitroglycerin, medicines used to treat high blood pressure, and Botox. 

In the most severe cases, surgery is considered. The most commonly used procedure is known as Lateral Internal Sphincterotomy, where a part of the internal sphincter is cut into so as to relax the tensions that are leading to the formation of fissures.

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