What is Chronic Anal Fissures? Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr A Venkateshwar Rao , Gastroenterologists Medical

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

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 provides a comprehensive overview of chronic anal fissures, including their causes, symptoms, risk factors, diagnosis, treatment options, and potential complications.

What are the Causes of Chronic Anal Fissure?

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 the anus can lead to fissures.
Inflammatory Diseases: Chronic anal fissures are more likely to develop in individuals with inflammatory bowel diseases such as Crohn's disease.
Impaired Blood Supply: Reduced blood flow to the anal region can delay healing and contribute to chronic fissures.

Underlying Health Conditions

Certain medical conditions can increase the risk of developing chronic anal fissures.

Crohn's Disease: Chronic inflammation associated with Crohn's disease can cause recurrent anal fissures.
Hypertonic Anal Sphincter: An overly tight anal sphincter muscle increases pressure in the anal canal and contributes to fissure formation.

What are the Symptoms of Chronic Anal Fissure?

The primary symptom of a chronic anal fissure is pain during and after bowel movements. The pain can be severe and may persist 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: Persistent itching, burning, and discomfort around the anus.
Visible Tear: A small tear or crack near the anus may be visible.
Severe Pain During Bowel Movements: Sharp or burning pain that may continue for hours after passing stool.
Blood in Stool: Bright red blood may appear on toilet paper or in the toilet after a bowel movement.

When to See a Doctor for Chronic Anal Fissure?

If you develop symptoms suggestive of a chronic anal fissure, consult a Medical Gastroenterologist promptly. Early diagnosis and treatment can help relieve pain, promote healing, prevent complications, and reduce the risk of recurrence.

If you experience severe or persistent pain during or after bowel movements.
If you notice bright red blood on the stool, toilet paper, or in the toilet after passing stool.
If your anal fissure does not heal within six to eight weeks despite home care or medications.
If you develop a visible tear, skin tag, or persistent swelling around the anus.
If you experience recurrent constipation, hard stools, or difficulty passing stools that worsen the fissure.
If you notice pus, fever, increasing redness, or foul-smelling discharge, which may indicate an infection.
If you have recurrent anal fissures or an underlying condition such as Crohn's disease that affects the anal region.
If your symptoms persist or worsen, consult a Medical Gastroenterologist promptly for a comprehensive evaluation, diagnosis, and appropriate treatment.

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How is Chronic Anal Fissure Diagnosed?

Clinical Examination

Diagnosing a chronic anal fissure typically involves a thorough clinical examination performed by a healthcare provider.

Visual Inspection: The doctor examines the anal area for visible tears, sentinel piles, skin tags, or other abnormalities.
Digital Rectal Examination: A gloved finger may be gently inserted into the rectum to assess sphincter muscle tone and identify underlying conditions when appropriate.

Additional Tests

Additional investigations may be recommended to rule out other anorectal or gastrointestinal conditions.

Anoscopy: A small tubular instrument is used to examine the anal canal and lower rectum.
Flexible Sigmoidoscopy or Colonoscopy: These procedures allow a detailed evaluation of the lower gastrointestinal tract when another underlying condition is suspected.

What are the Treatment Options for Chronic Anal Fissure?

Conservative Treatments

Initial treatment for chronic anal fissures usually involves conservative measures to relieve symptoms and promote healing.

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

Medical Interventions

If conservative treatment fails, more advanced medical or surgical options may be recommended.

Botulinum Toxin (Botox) Injections: Botox temporarily relaxes the anal sphincter muscle, promoting healing.
Lateral Internal Sphincterotomy: This surgical procedure reduces anal sphincter pressure to facilitate healing.
Anal Fissurectomy: Surgical removal of the chronic fissure and scar tissue may be considered in selected cases.

Dietary Changes

A high-fiber diet, adequate fluid intake, and regular bowel habits help soften stools, reduce constipation, and lower the risk of recurrent fissures.

Topical Treatments

Prescription or over-the-counter creams containing nitroglycerin, calcium channel blockers, or hydrocortisone may reduce inflammation, improve blood flow, and relieve sphincter spasm to support healing.

Pain Management

Warm sitz baths, pain-relieving ointments, and prescribed medications can help reduce discomfort while the fissure heals.

Signs of Healing

As healing progresses, pain and bleeding during bowel movements gradually decrease, and the fissure becomes smaller with less inflammation.

Chronic Anal Fissure Surgery

Surgery may be recommended when medical therapy fails. Lateral internal sphincterotomy is the most commonly performed procedure and has a high success rate in promoting long-term healing.

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What are the Complications of Chronic Anal Fissure?

Persistent Pain and Discomfort

Untreated chronic anal fissures can significantly affect quality of life and may lead to several complications.

Infection: Chronic fissures can become infected, leading to abscess formation or anal fistulas.
Scar Tissue Formation: Repeated tearing and healing may result in fibrosis and scar tissue, making healing more difficult.
Fecal Incontinence: Although uncommon, surgical treatment may rarely result in difficulty controlling bowel movements.

What are the Risk Factors for Chronic Anal Fissure?

Several factors can increase the likelihood of developing a chronic anal fissure.

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: A low-fiber diet can contribute to constipation and increase the risk of anal fissures.
Lifestyle: A sedentary lifestyle may contribute to bowel irregularities and constipation.

What are the Home Remedies for Chronic Anal Fissure?

While professional medical treatment is often necessary for chronic anal fissures, some home remedies may provide additional relief and support healing.

Aloe Vera: Applying aloe vera gel to the affected area may soothe irritation and promote healing.
Coconut Oil: This natural moisturizer may help lubricate the anal area, making bowel movements more comfortable.
Essential Oils: Certain essential oils, such as lavender or tea tree oil, may have anti-inflammatory properties. They should only be used after proper dilution and medical advice.

How to Live with Chronic Anal Fissure?

If you have a chronic anal fissure, the following lifestyle measures can help promote healing and reduce the risk of recurrence:

Do not stop taking prescribed medications without consulting your healthcare provider.
Eat a high-fiber diet to prevent constipation and hard stools.
Drink plenty of water to stay well hydrated.
Maintain regular bowel habits and avoid straining during bowel movements.
Avoid spicy foods if they worsen your symptoms.

How is Chronic Anal Fissure Different from Acute Anal Fissure?

An anal fissure is a small tear in the lining of the anus. Acute anal fissures usually heal within a few weeks with conservative treatment, whereas chronic anal fissures persist for more than six weeks and often require specialized medical or surgical treatment. Chronic fissures may also be associated with a sentinel skin tag, making them more difficult to heal.