What is an anal fissure?

An anal fissure is a small cut or tear in the lining of the anus. The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times, the fissure can be deep enough to expose the muscle tissue underneath. 

In most cases, the tear heals on its own within four to six weeks. 

In cases where the fissure persists beyond eight weeks, it’s considered chronic.

Certain treatments can promote healing and help relieve discomfort, including stool softeners and topical pain relievers.If an anal fissure doesn’t improve with these treatments, you may need surgery

Symptoms of an anal fissure?

An anal fissure may cause one or more of the following symptoms:

 a visible tear in the skin around your anus 

a skin tag next to the tear 

sharp pain in the anal area during bowel movements

 streaks of blood on stools or on toilet paper after wiping burning or itching in the anal area

What causes an anal fissure?

An anal fissure most often occurs when passing large or hard stools.  

Chronic constipation or frequent diarrhea can also tear the skin around your anus.

Other common causes include: 

straining during childbirth 

bowel movements inflammatory bowel disease (IBD), such as Crohn’s disease 

decreased blood flow to the anorectal area overly tight or spastic anal sphincter muscles

How is an anal fissure diagnosed?

A doctor can usually diagnose an anal fissure simply by examining the area around the anus. However, they may want to perform a rectal exam to confirm the diagnosis.

Using an anoscope may also help your doctor find other causes of anal or rectal pain such as hemorrhoids.

How is an anal fissure treated?

Most anal fissures don’t require extensive treatment. However, certain home remedies can help promote healing and relieve uncomfortable symptoms. You can treat an anal fissure at home by: 

using over-the-counter stool softeners

 drinking more fluids taking fiber supplements and eating more fibrous foods, such as raw fruits and vegetables

taking a sitz bath to relax the anal muscles, relieve irritation, and increase blood flow to the anorectal area applying a nitroglycerin ointment to promote blood flow to the area or a hydrocortisone cream, to help with inflammation applying topical pain relievers, such as lidocaine, to the anus to ease discomfort

If your symptoms aren’t relieved within two weeks of treatment, see your doctor for further evaluation. 

Another possible treatment is Botoxin injections into the anal sphincter. The injections will prevent spasms in your anus by temporarily paralyzing the muscle. This allows the anal fissure to heal while preventing new fissures from forming.

Surgery

If your anal fissure fails to respond to other treatments, your doctor may recommend lateral internal sphincterotomy (anal fissurectomy). This surgical procedure involves making a small incisionin the anal sphincter to relax the muscle. Relaxing the muscle allows the anal fissure to heal. 

Anal fissure Prevention?

An anal fissure can’t always be prevented, but you can reduce your risk of getting one by taking the following preventive measures:  

  • Keeping the anal area dry cleansing the anal area gently with mild soap and warm water drinking plenty of fluids,  
  • Eating fibrous foods, and exercising regularly to avoid constipation
  • Treating diarrhea immediately changing infants’ diapers   

Takeaway

Anal fissures may cause sharp pain and small amounts of bright red blood with bowel movements. If it becomes achronic anal fissure, skin tags may develop in the area associated with achronic local infection.Conditions associated with anal fissures include previous anal surgeries, inflammatory bowel disease, local cancers, and sexually transmitted diseases.Some conditions that may more directly lead to anal fissures are ones that induce trauma to the area, such as vaginal delivery, anal sex, or passing hard stool.