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Anal fissure

Overview

An anal fissure is a small tear or crack in the skin around the anus that can cause pain, discomfort, and sometimes bleeding during bowel voiding. Anal fissures can affect people of all ages; however, they are more frequently encountered in individuals who experience chronic constipation.

Anal fissures typically occur when the skin around the anus is stretched or torn due to various factors. Common causes include:

  • Constipation: Passing large or hard stools can cause strain, leading to tears in the anal skin.
  • Chronic diarrhoea: Frequent bowel movements can irritate and damage the delicate skin around the anus.
  • Childbirth: Vaginal delivery can cause trauma or stretching to the anal area.
  • Anal intercourse: This can sometimes lead to tearing of the anal skin.
  • Poor blood flow: Reduced circulation to the area, often due to conditions like diabetes or anal trauma, may hinder healing.
  • Infections: Certain infections (e.g., sexually transmitted infections) may result in fissures.
  • Inflammatory bowel disease (IBD): IBD can lead to anal fissures.

Common symptoms include:

  • Visible tear: A small crack or tear might be visible in the skin around the anus, though it is not always obvious.
  • Pain: The hallmark symptom of anal fissure is sharp or burning pain during or after a bowel movement. The pain may last from minutes to hours.
  • Bleeding: The tear might cause bleeding (bright red blood on toilet paper or in the toilet bowl).
  • Itching or irritation: Affected individuals may feel itchy or an irritating sensation in the area around the anus.
  • Spasms: Some people experience painful muscle spasms in the anal sphincter muscle, which can worsen the pain.

Anal fissures are diagnosed based on the following:

  • Physical examination: A simple visual inspection of the anal area is often enough to identify a fissure.
  • Anoscopy or proctoscopy: In some cases, a doctor may use a small instrument (anoscope or proctoscope) to get a closer look at the anal canal.
  • Other tests: If there are concerns about underlying conditions like IBD or infection, blood tests or stool cultures may be performed.

Most anal fissures are acute (short-term) and can heal with conservative treatments, but chronic (long-term) fissures may require more advanced intervention.

  • Conservative (non-surgical) treatment:
    • Increasing the fibre intake: Eating a high-fibre diet helps soften the stool and decreases straining during bowel voiding.
    • Stool softeners: These can be used to make bowel movements easier and less painful.
    • Warm water baths: Soaking the affected area in warm water for 10–15 minutes daily (a few times) can provide pain relief and promote healing.
    • Analgesic creams: These can help manage pain.
  • Medical treatments
    • Botox injections: Botulinum toxin (Botox) can be injected into the anal sphincter muscle to relax it and help heal chronic fissures.
    • Topical hydrocortisone or nitroglycerin: These creams can help reduce pain, inflammation, and itching. Further, they promote healing,and relax the anal sphincter to ease muscle spasms.
    • Calcium channel blockers: Topical medications like diltiazem or nifedipine can relax the anal sphincter and reduce spasms, promoting healing.
  • Surgical treatment (for chronic fissures): If conservative treatments fail and the fissure becomes chronic (lasting more than 6-8 weeks), surgical options may be considered:
    • Lateral internal sphincterotomy: In this surgery, a small portion of the anal sphincter is cut to relieve pressure, thereby promoting healing.
    • Fissurectomy: This surgery involves removal of the fissure and surrounding scar tissue.
    • Flap surgery: In rare cases, a tissue flap from nearby areas is used to cover a chronic fissure that is not healing.

Consult a medical professional if you have persistent pain or bleeding during bowel movements.

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