Anal fissure: Symptoms, Causes & Best Treatment & Surgery

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:


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:


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.

Do’sDon’ts
Add fiber to your dietHave foods such as popcorn, nuts or tortilla chips.
Drink adequate fluidsTake alcohol
Take a sitz bathConsume constipating foods
Exercise regularlyUse hemorrhoid suppositories


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.

Citations

https://academic.oup.com/bjs/article/91/3/270/6143645
https://link.springer.com/article/10.1007/s00268-005-0664-y
https://www.sciencedirect.com/science/article/abs/pii/S0889855305701722
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0035-1570390

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Frequently Asked Questions

1. What are anal fissures?

Anal fissures are tiny holes or cuts in the anus lining., causing discomfort, pain, and sometimes bleeding during bowel movements.

2. What are the common symptoms of anal fissures?

Common symptoms include sharp pain during bowel movements, blood on the toilet paper or in the stools, itching, burning, and discomfort in the anal area.

3. What causes anal fissures?

Anal fissures can be caused by factors such as constipation, straining during bowel movements, hard stools, prolonged diarrhea, and childbirth. These factors can lead to trauma and tearing of the anal lining.

4. How are anal fissures diagnosed?

An examination of the anal region by a healthcare professional is typically required for diagnosis. Sometimes, additional tests such as a digital rectal exam or anoscopy may be performed to confirm the diagnosis.

5. What is the best treatment for anal fissures?

Treatment options for anal fissures depend on their severity. Conservative approaches include dietary changes, increased water intake, fiber supplements, and topical creams. In more severe cases, medical procedures or surgery may be recommended.

6. What is the medical procedure for treating anal fissures?

Medical procedures for anal fissures include methods like lateral internal sphincterotomy and Botox injections. These procedures aim to relax the anal sphincter muscle and promote healing.

7. When is surgery necessary for anal fissures?

When non-surgical treatments are unsuccessful, surgery may be considered. Anal fissure surgery involves removing a small portion of the anal sphincter muscle to reduce pressure on the fissure and promote healing.

8. What are the symptoms of chronic anal fissures?

Chronic anal fissures can cause ongoing pain, bleeding, and discomfort. Some individuals might experience spasms of the anal sphincter muscle, which can exacerbate the pain.

9. How is an anal fissure surgery performed?

Anal fissure surgery typically involves a procedure called lateral internal sphincterotomy. During this surgery, a small portion of the internal anal sphincter muscle is cut to reduce pressure and promote healing.

10. Can anal fissures be treated without surgery?

Yes, many cases of anal fissures can be treated without surgery. Conservative approaches, dietary changes, and topical treatments can often help in healing fissures.

11. Can anal fissures heal on their own?

In some cases, small anal fissures might heal on their own with proper hygiene, dietary adjustments, and self-care measures. However, chronic or severe fissures may require medical intervention.

12. What should I do if I notice blood after a bowel movement?

If you notice blood on toilet paper or in the stool, it's important to consult a healthcare provider. While it might be due to something minor like anal fissures, it's essential to rule out more serious conditions.

13. Is there any way to prevent anal fissures?

Maintaining a healthy diet rich in fiber, drinking plenty of water, avoiding straining during bowel movements, and practicing good anal hygiene can help reduce the risk of developing anal fissures.

14. Can anal fissures be mistaken for other conditions?

Yes, anal fissures can sometimes be mistaken for conditions like hemorrhoids or inflammatory bowel disease due to similar symptoms. A proper medical evaluation is necessary for an accurate diagnosis.

15. Is a "cut on the anus" the same as an anal fissure?

Yes, a "cut on the anus" is another way to describe an anal fissure. It refers to a tear or small cut in the lining of the anus.