Chronic Anal Fissures: Symptoms and Treatments

Chronic anal fissures are a persistent and often painful condition that affects many individuals. Unlike acute anal fissures, which typically heal within a few weeks, chronic anal fissures can last for more than six weeks and may require more intensive treatment. This article aims to provide a comprehensive overview of chronic anal fissures, including their causes, symptoms, risk factors, diagnosis, treatment options, and potential complications.

Chronic Anal Fissure vs. Acute Anal Fissure

An anal fissure is a small tear in the lining of the anus. Acute anal fissures are short-term and usually heal within a few weeks with conservative treatment. In contrast, chronic anal fissures persist beyond six weeks and often require more specialized care. Chronic fissures may also develop a sentinel pile, a small skin tag that forms at the end of the fissure, making the condition more challenging to treat.

Chronic Anal Fissure Causes

Physical Strain and Trauma

Chronic anal fissures can result from prolonged physical strain or trauma to the anal canal. Common causes include:

Constipation: Straining during bowel movements can cause tears in the anal lining.
Diarrhea: Frequent loose stools can irritate and damage the anal tissue.
Childbirth: The strain of vaginal delivery can lead to anal fissures.
Anal Sex: Overstretching of the sensitive skin around your anus can lead to fissures.
Inflammatory Diseases: Chronic anal fissures may be more likely to develop in patients with certain inflammatory diseases like Crohn’s disease or other types of inflammatory bowel disease.
Impaired Blood Supply: There is less blood flow to the anal region, which is necessary for healing, may lead to chronic fissures.

Underlying Health Conditions

Certain medical conditions can predispose individuals to developing chronic anal fissures:

Crohn's Disease: This inflammatory bowel disease can cause chronic inflammation and fissures.
Hypertonic Anal Sphincter: An overly tight anal sphincter muscle can contribute to the formation of fissures.

Get a second opinion from trusted experts and makeconfident, informed decisions.

Get Second Opinion

Chronic Anal Fissures Symptoms

The primary symptom of a chronic anal fissure is pain during and after bowel movements. This pain can be severe and may last for several hours. Other symptoms include:

Bleeding: Small amounts of bright red blood may be visible on toilet paper or in the stool.
Itching and Irritation: Chronic fissures can cause persistent itching and discomfort.
Visible Tear: In some cases, the fissure can be seen as a small tear near the anus.
Severe Pain During Bowel Movements: Perhaps the most defining symptom is severe pain, a jabbing sensation that can linger for hours after a bowel movement.
Blood in Stool: After a bowel movement, bright red blood may appear on toilet paper or in the toilet.

Risk Factors for Chronic Anal Fissures

Several factors can increase the risk of developing chronic anal fissures:

Age: Young adults and middle-aged individuals are more commonly affected.
Gender: Both men and women are equally susceptible, although postpartum women may have a higher risk.
Diet: Low-fiber diets can lead to constipation and increase the risk of fissures.
Lifestyle: Sedentary lifestyles can contribute to bowel irregularities and fissures.

Diagnosis of Chronic Anal Fissures

Clinical Examination

Diagnosing chronic anal fissures typically involves a thorough clinical examination by a healthcare provider. This may include:

Visual Inspection: The doctor will examine the anal area for visible tears, sentinel piles, or other abnormalities.
Digital Rectal Exam: A gloved finger may be inserted into the rectum to assess muscle tone and identify any underlying issues.

Additional Tests

In some cases, additional tests may be required to rule out other conditions:

Anoscopy: A small, tubular instrument is used to inspect the anal canal and rectum.
Flexible Sigmoidoscopy or Colonoscopy: These procedures allow for a more comprehensive examination of the lower gastrointestinal tract.

Chronic Anal Fissure Treatment

Conservative Treatments

Initial treatment for chronic anal fissures often involves conservative measures:

Dietary Changes: Increasing fiber intake and staying hydrated can help soften stools and reduce strain during bowel movements.
Stool Softeners: Over-the-counter stool softeners can make bowel movements less painful.
Sitz Baths: Soaking the anal area in warm water several times a day can promote healing and relieve discomfort.
Topical Medications: Prescription creams or ointments containing nitroglycerin, calcium channel blockers, or corticosteroids can help relax the anal sphincter and reduce pain.

Medical Interventions

If conservative treatments are ineffective, more advanced medical interventions may be necessary:

Botox Injections: Botulinum toxin can be injected into the anal sphincter to paralyze the muscle, promoting healing temporarily.
Lateral Internal Sphincterotomy: This surgical procedure involves cutting a small portion of the anal sphincter muscle to reduce tension and facilitate healing.
Anal Fissurectomy: In severe cases, surgical removal of the fissure and surrounding tissue may be required.

Dietary Changes (Chronic Anal Fissure Diet)

A high-fiber diet helps soften stools, making bowel movements less painful and reducing strain. Drinking plenty of water and eating fruits, vegetables, and whole grains can prevent constipation, a common cause of fissures.

Topical Treatments (Anal Fissure Cream)

Over-the-counter anal fissure creams, such as hydrocortisone or those containing nitroglycerin, help reduce inflammation, increase blood flow, and relax the anal sphincter, making it easier for the fissure to heal.

Pain Management

If the fissure pain is unbearable, pain-relieving ointments or warm sitz baths can offer relief. Sitz baths help soothe the affected area and promote healing by increasing blood flow to the region.

Signs a Fissure is Healing

As the fissure heals, pain during and after bowel movements should decrease. The fissure may appear smaller and less red, and bleeding should diminish. If pain or bleeding persists, further treatment may be needed.

Chronic Anal Fissure Surgery

If conservative treatments fail, chronic anal fissure surgery might be necessary. Options include lateral internal sphincterotomy, which involves cutting a small portion of the anal sphincter to relieve muscle tension, allowing the fissure to heal.

Complications of Chronic Anal Fissures

Persistent Pain and Discomfort

Chronic anal fissures can significantly impact an individual's quality of life due to persistent pain and discomfort. Left untreated, these fissures can lead to more severe complications:

Infection: Chronic fissures can become infected, leading to abscesses or fistulas.
Scar Tissue Formation: Repeated tearing and healing can result in the formation of scar tissue, which can further complicate treatment.
Faecal Incontinence: In rare cases, surgical interventions may result in faecal incontinence or difficulty controlling bowel movements.

Your health is everything - prioritize your well-being today.

Schedule Your Appointment

Home Remedies for Chronic Anal Fissures

While professional medical treatment is often necessary for chronic anal fissures, some home remedies may provide additional relief:

Aloe Vera: Applying aloe vera gel to the affected area can soothe irritation and promote healing.
Coconut Oil: This natural lubricant can help ease bowel movements and reduce discomfort.
Essential Oils: Certain essential oils, such as lavender or tea tree oil, have anti-inflammatory properties that may aid in healing.

Living with Chronic anal fissures

You get an anal fissure, take these steps to help prevent it from getting worse and avoid repeats:

Do not stop taking any medicines without speaking with your health care provider.
Eat the recommended amount of fiber. Constipation or very large or hard stools
Make sure you drink sufficient water to stay well hydrated.
Bowel habit should be regular. Check with your health care provider about what this should be for you.
Steer clear of spicy foods while you have an anal fissure, since they can exacerbate symptoms.

Find Our Specialists