What Is An Anal Fissure?

An anal fissure is a tear in the lining of the anal canal. It causes severe pain that gets worse on passing stool or gas and can be associated with bleeding.

Anal fissures can occur in patients of any age. The treatment depends on the severity of the fissure. Mild to moderate cases are treated medically. However, in chronic cases, surgical approaches can be adopted.

Anal fissures are common in people who have inflammatory bowel disease (Crohn's disease, ulcerative colitis) and in women after childbirth because of underlying muscle damage.

What are the causes of Anal Fissure?

Common causes are -

• Constipation
• Excessive Straining during a bowel movement
• Anal fissures can also result from Anal Sexual Intercourse.
• Anal fissures may also occur in infants because of passing meconium, or first stool, during the first days after birth.
• Severe Diarrhoea and infections may cause anal fissures as well.

What are the symptoms of Anal Fissures?

Symptoms may develop acutely or may be chronic and include:

• Sharp pain on bowel movements, often getting worse with the passage of each stool, usually last up to half an hour after passing stool
• Bright red blood covering the stool after a bowel movement
• Soreness and tenderness around the anus
• Skin that is swollen around the anus

How are Anal Fissures diagnosed?

Diagnosis is most often straightforward and is done by a thorough clinical examination by your doctor. An additional sigmoidoscopy or colonoscopy may be ordered to rule out any other coexisting conditions.

How are Anal Fissures treated?

An anal fissure treatment is usually simple and carried out at home by the patient. Cleanliness and proper treatment can help to reduce the risk of complications such as infection, and recurrence of an anal fissure. If treatment does not resolve discomfort within a few days, please see your doctor (or seek treatment at a local emergency room) as treatment options may be expanded.

• Sitz baths (warm water, allowing the area to become heated; this too will relax the muscles)
• Pain relief ointments
• Stool softeners (to soften the stools)
• Treatment may require dietary changes to promote healing, such as adding fibre and drinking more fluids.
• Applying topical creams or suppositories containing glyceryl trinitrate (GTN) to the anal canal four times daily. The cream/suppository decreases spasms of the internal sphincter muscle by increasing blood flow to the area and allowing the internal sphincter muscle to relax.

In severe cases of anal fissure where treatment with GTN or botulinum toxin injections does not work, treatment with rubber band ligation is usually effective. This treatment causes scarring within the anal canal, which eventually causes the tear in the anus to heal up.

If there is no response to these measures a small surgical procedure called a lateral sphincterotomy may be considered as well.

How can anal fissures be prevented?

Anal fissure prevention is related to avoidance of constipation and straining during bowel movements. Some steps that can be taken include –

• Constipation prevention steps:
• Drinking plenty of fluids
• Eating fibrous foods
• Exercising regularly to avoid constipation.
• Treatment of any underlying causes such as Crohns etc