Anal Fissure- Causes, Symptoms, Diagnosis, and Treatment

A small tear or cut adjacent to the lining of the anus is deemed as a fissure. Owing to this crack, you can witness blood while you pass stool. Also, unbearable pain to add to your discomfort. In few cases, the fissure is so deep that it exposes the skin beneath the anus. Though the disease does not pose any real-life threat, yet taking care of the same is always advised. Generally, young people and the infants are exposed to fissure and constipation is one of the major problems in that age.

Generally, it takes near about four to six week for self-recovery. However, if in this duration the tear does not heal then you must seek medical aid as the condition is chronic. Certain medical aid soothes pain and also help in healing better and faster. In case, if the fissure persists, you need to opt for surgery.

Causes of Anal Fissure 

As stated, an anal fissure is tearing apart of the lining of the anus and is majorly caused when you apply extra pressure on the anus. Passing large or hard stool mainly deem as the cause behind the same. Constipation or diarrhoea might worsen the case. Other causes that are largely the same in all includes:

  • Passing large and hard stools
  • Constipation or bowel movement straining
  • Chronic diarrhoea
  • Anorectal area inflammation majorly caused due to the presence of the Crohn’s disease or any other inflammatory bowel disease
  • Childbirth

Few of the uncommon or the rarely occurring causes are

Symptoms of Anal Fissure 

The presence of anal Fissure can be supported by one of the following signs:

  • A tear is adjacent to the skin of anus that is largely visible.
  • A noticeable pain while passing stools.
  • A skin lump adjacent to the skin opening or tear.
  • A sense of burning near the anus.
  • Patches of blood on stools.
  • Itching in the anus.

Risk Factors of Anal Fissure

Anal Fissure is a common phenomenon during infancy. Also, the fact that with ageing the blood flow to the area of the anus and rectum largely decreases and so adults are exposed to the disease. A pregnant women experiences straining and so are at high risk of getting anal Fissure. People suffering from IBD are also exposed to greater risk of developing anal cancer. An inflammation that occurs on the lining of the anal increases the chance of the tissue getting tampered and damaged. Also, individual with problems as constipation are at high risk as fissure is caused due go passage of hard and large stools.

Summing up the entire plot:

  • Aged People
  • Constipation
  • Infancy
  • Anal Intercourse
  • Crohn’s Disease
  • Childbirth

Several complications related to the disease include:

  • Incapability to heal: Fissures that cannot heal in six months are exposed to chronic illness and hence seek further treatment.
  • Recurrence: There is no surety that if you have a fissure once, you might not have the same again. Once you have a fissure, you are at greater risk of having the same again later in life.
  • Tear expanding to the nearby muscles: One of the most difficult scenarios is your tear in the anus spreading to the adjacent muscles that hold the anus closed. This makes healing more difficult and might turn chronic thereby necessitating the need for surgery. Unwanted pain and discomfort pose serious life threat.

Diagnosis of Anal Fissure

The most convenient way to diagnose a fissure is inserting a gloved finger inside the anal to perform an anorectal exam. Your doctor might be interested in a digital exam, and this would need inserting the finger or a short and light tube inside the canal of the anus for a better perspective. If you find the above method painful and unbearable, then the doctor would only seek observation to conclude the presence of fissure.

Anal fissure with acute symptoms appears as a fresh cut or tear. However, the one which is chronic would have a tear and also two sags skin or lumps one internal and other external. The location of the fissure is effective in stating the cause of the same. If your fissure is located adjacent to the opening of the anus, then it is likely that the fissure is caused due to any other chronic disease as the Crohn’s Disease. In such a scenario, your doctor might suggest performing certain lab tests to rule out the symptoms.

1. Flexible Sigmoidoscopy:

One of the most imperative tests to see whether or not your fissure is due to the presence of Crohn’s Disease is the flexible Sigmoidoscopy. In this process, a thin tube is inserted into the colon that has a camera attached at the other end. The presence of the camera helps the doctor to have a clearer view of the anorectal region. If you are younger or less than 50 years, then the doctor can opt for this test. This test is done if you have no symptoms of colon cancer.

2. Colonoscopy:

Here also, a flexible tube is inserted inside the rectum to have a wider view of the colon. For people above 50 years of age and with a risk of colon cancer, the doctor prefers Colonoscopy. Doctors perform the above test for patients with high risk of cancer and abdominal pain or diarrhoea issues.

3. Anoscopy:

Sometimes doctors have the doubt of the presence of Hemorrhoids and to rule out the symptoms of the same, doctors opt for an anoscope. An additional endoscopy would be beneficial and leads to a better evaluation of the disease.

Only after the doctor affirms it, they will go for a treatment and seek a further assessment. Though the procedure might seem painful if done with care does not induce discomfort to the patient suffering from Fissure.

Treatments of Anal Fissure

Though in most of the cases, an anal Fissure does not need any treatment yet undertaking certain home remedies would help you ease pain and discomfort if any. It is advisable to undertake certain measures to facilitate healing and also relieve from symptoms of pain and discomfort. You can do the following to treat anal fissure at home.

  • Prefer taking over the counter softener of stool.
  • Drink plenty of fluids.
  • Increase the intake of fiber filled food, and you can look to switch to fiber supplements.
  • You can take a sitz bath to soothe anal pain, relieve discomfort, ease pain and irritation and also boost the blood flow to the anorectal region.
  • Prefer applying topical pain relievers to reduce pain and discomfort.
  • Application of nitroglycerin ointment promotes the flow of blood to the anorectal region or a hydrocortisone lotion like Crotizone 10 is largely helpful in reducing inflammation.

Try performing the above for two weeks. Even after that if you continue to have pain and discomfort, then your doctor would need to perform additional tests and procedures to see what could be the cause and also indices better treatment and take measure to cure the disease. Your doctor would now need to perform the correct lab tests and accordingly treat the disease.

An ointment of calcium channel blocker is effective in relaxing the muscles of a sphincter and leads to better healing of the anal pain. Several doctors suggest the patients take botox injections. These injections are given directly to the anal sphincter and are very effective in preventing the spasms that occur in the anus. The botox injections paralyse the muscle, and hence spasms are prevented. This not just heals the concurrent fissure nut also prevents new fissure from forming.

Even after this, if the anus does not appear to heal, then the doctor is left with only one option as anal sphincterotomy. A small incision inside the anus to relax the muscle and the nearby areas. Once, the anal muscle or the region relaxes, it becomes easier for the fissure to heal.

However, it is not necessary that all the anal Fissures are the result of a bad bowel movement or low fibre diet. If your fissure is not healing effectively, then it suggests the presence of any other cause. This is the same for all anal fissures that are not located in the posterior region or for that matter the middle area of the anus. If after trying all the home remedy, your fissure still does not show signs of healing then you must immediately contact a doctor.

It is not advisable to delay any major symptoms. It is true that anal fissures do not require treatment for most of the cases, but if your fissure does not improve in a week or two, then you must not ignore the signs and directly visit a doctor or a specialist. Your doctor will assess and examine all the signs, symptoms and then conclude the cause of the disease. This would help the doctor to seek better treatment and the right treatment for you.

Though it is not feasible to prevent the fissure totally, yet if you undertake certain measures, you can easily reduce the risk of exposure to fissure all your life. Some of the tips to induce in your daily life activities to stay away from anal fissures includes keeping your anal area both dry and clean. Always stay hygienic. Wash the area with soap and warm water. In case the disease is to an infant, change diapers immediately. Drink plenty of fluids, eat more fibrous food and always treat red diarrhoea.

Sagar Papneja

For me, health is about sustainable living and consuming environmentally conscious food; I am a vegan.

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