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An overview of anal fissures: Symptoms, causes and treatment

  • Posted on- Jul 04, 2015
  • 2362 Views

An anal fissure is a tear in the lining of the anus or anal canal (the opening through which stool passes out of the body). The fissure can be painful and may bleed.

Signs and symptoms of an anal fissure

Signs and symptoms include:
  • Pain during, and even hours after a bowel movement
  • Constipation
  • Blood on the outside surface of the stool
  • Blood on toilet tissue or wipes
  • A visible crack or tear in the anus or anal canal
  • Burning and itch that may be painful
  • Discomfort when urinating, frequent urination, or inability to urinate
  • Foul-smelling discharge

Causes of an anal fissure

Anal fissures can be caused by trauma to the anus and anal canal. The cause of the trauma can be one or more of the following:
  • Chronic constipation
  • Straining to have a bowel movement
  • Prolonged diarrhoea
  • Anal sex, anal stretching
  • Insertion of foreign objects into the anus

Causes other than trauma include:
  • Longstanding poor bowel habits
  • Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)
  • Scarring in the anorectal area
  • Presence of an underlying medical problem such as Crohn's disease and ulcerative colitis
  • Decreased blood flow to the anorectal area

Diagnosis of an anal fissure

Usually your doctor can diagnose an anal fissure by visual inspection of the anus or by gentle exam with the tip of the finger.

Risk for the development of anal fissures

Anal fissures can occur in anyone at any age. Generally, the chance of an anal fissure occurring decreases as age increases. However, people who have had fissures in the past are more likely to have them in the future.

Treatment of anal fissures

The goal of treatment is to lower the pressure on the anal canal by making stools soft as well as easing pain and bleeding. Conservative treatments are tried first and include one or more of the following:
  • Preventing constipation through the use of stool softeners, increased intake of fluids while avoiding caffeine-containing products (which cause dehydration), and dietary adjustments (increase in intake of high fibre foods and fibre supplements).
  • Soaking in a warm bath, 10 to 20 minutes several times a day, to promote the relaxation of the anal muscles.
  • Cleansing the anorectal area more gently
  • Avoiding straining or prolonged sitting on the toilet
  • Using petroleum jelly to help lubricate the anorectal area

When treatments fail and anal fissures persist or recur other measures can be tried, including:
  • Using hydrocortisone-containing suppositories, foams, or creams to reduce inflammation
  • Applying other creams and ointments these may include a medicated cream
  • Injecting botulinum toxin type A (Botox) into the anal sphincter. The injection temporarily paralyzes the anal sphincter muscle, relieving pain and promoting healing
  • Surgery

Prevent the development of an anal fissure

For fissures in infants: Change diapers frequently and treat constipation

For fissures in adults:
  • Keep the anorectal area dry
  • Wipe the area with soft materials, a moistened cloth, or cotton pad avoid rough and scented toilet paper
  • Promptly treat all occurrences of constipation and diarrhoea
  • Avoid irritating the rectum