CONDITIONS
Anal Fissures
Anal Fissure Diagnosis: Recognizing and Managing Anal Tear
What is anal fissure?
An anal fissure is a crack or tear in the lining of the anal canal.
Anal fissures can cause significant discomfort during bowel movements, which in turn can cause difficulties, such as constipation or a decrease in frequency. Additionally, anal fissures may also cause bleeding from the anus.
Anal fissures are very common, particularly in infants and young children, as well as in pregnant women.
What causes anal fissures?
Anal fissures are frequently caused by trauma, such as stretching and straining, which can result in a tear in the lining of the anus. The main causes include:
- Constipation with straining to pass hard stool
- Intense diarrhoea
- Pregnancy
- Vaginal childbirth
- Anal sex
- Recent weight loss surgery, because it leads to frequent diarrhoea
- Eating a low-fiber diet
Anal fissures can also be caused by inflammatory bowel disease, surgical procedures, or other medical interventions that impact bowel movements or the anal area.
What are the common symptoms of anal fissure?
Anal fissures may cause:
- Sharp, stinging pain during bowel movement that can persist for a few minutes to a few hours afterward.
- Additionally, one might feel a cutting or tearing sensation during the bowel movement. This pain can lead to the urge to withhold bowel movements, causing constipation. Consequently, this can exacerbate the anal fissure, making it more difficult to pass stools. Furthermore, the pain can trigger spasms in the muscles surrounding the anal canal, hindering the healing process and intensifying the discomfort. This recurring pattern of pain and spasms is called the fissure cycle.
- Presence of bright red blood in bowel movements after a bowel movement.
- It is common to find a skin tag (a small lump of skin) near the anal fissure, especially when the anal fissure has been persistent for more than 8 weeks.
How is anal fissure diagnosed?
An anal fissure is typically diagnosed through medical history and physical examination.
Medical history: The doctor will ask questions about symptoms, such as experiencing pain during bowel movements, noticing blood in stool, or having other related symptoms like itching or discomfort.
Physical examination: A visual inspection of the anal area may reveal the presence of a fissure. The doctor will look for signs like a small tear or open sore in the skin around the anus. A gloved finger may also gently examine the area for tenderness or other abnormalities.
How is anal fissure treated?
Anal fissures often heal within a few weeks with measures to soften stools, which includes:
- Increase in fiber intake (eat more fresh fruits, vegetables, and whole grains)
- Drinking plenty of fluids.
- Taking warm sitz baths for anal sphincter relaxation (i.e., soaking in plain warm water for 10 to 20 minutes several times a day).
Medications
- Stool softeners or laxatives to make bowel movement softer
- Topical medicines, such as nitrates or calcium blockers, to apply around the anus to help reduce pressure, relieve pain, and make it easier to have a bowel movement.
- Administering Botox injections to the anal sphincter muscles can aid in their relaxation. Botox functions as a muscle relaxant, with its effects lasting for three months, allowing ample time for the fissure to heal.
Surgery
If an anal fissure does not heal with medication or it comes back after healing, a minor surgical procedure may be necessary to end the cycle. The procedure is called an internal sphincterotomy. While asleep under sedation, a colorectal surgeon makes a small cut into the anal sphincter muscle to release tension permanently.
How can one prevent anal fissures?
Adopting some simple self-help measures can make going to the toilet easier. This will help existing fissures to heal while reducing the likelihood of developing new ones. These strategies include:
- Ensure an adequate intake of fiber by incorporating fruits, vegetables, whole grains, and legumes into their diet. It is recommended for adults to consume at least 30 g of fiber per day.
- Maintaining proper hydration by consuming enough fluids.
- Avoid ignoring the urge to defecate, as this can cause stool to dry out and make it harder to pass.
- Engaging in regular exercise, aiming for at least 150 minutes of physical activity per week.
In summary, an anal fissure is a tear in the lining of the anus, often causing pain and discomfort, especially during bowel movements. It can result from various factors like constipation, diarrhoea, or childbirth. Symptoms include pain, burning, itching, and sometimes bleeding. Diagnosis involves a medical history review and physical examination. Treatment focuses on symptom relief and healing, including dietary changes and topical medications. If these treatment options do not help, then sometimes doctors might suggest other options like injections or surgery.
References
- Cleveland Clinic. Anal Fissures. Available from: https://my.clevelandclinic.org/health/diseases/13177-anal-fissures. Accessed on May 15th, 2024
- Johns Hopkins Medicine. Anal fissures. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/anal-fissures. Accessed on May 15th, 2024
- Memorial Sloan Kettering Cancer Center. Patient & Caregiver information. About anal fissures. Available from: https://www.mskcc.org/pdf/cancer-care/patient-education/about-anal-fissures?mode=large. Accessed on May 15th, 2024