Anal Fissure: What It Is, Symptoms, Causes & Treatment

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Introduction

Understanding the meaning of fissure in medical terms enables a person to understand the fissure and its treatment better. However, it becomes an article of discomfort in an individual’s life when it is accompanied by pain along with bleeding after passing stool. Small tears, fissures in the anal canal, usually cause great pain during and following defecation. They stop a man from living a normal life.

In this regard, people can understand the pain experienced by the common symptoms of fissure and their causes, which are examined in this write-up, along with fissure and its treatment. Recognizing the signs means that one can take action to ease the pain and help in the recovery process.

What is an anal fissure?

Anal fissures are a small tear or crack in the anus lining, more often than not caused by passing a stool that is either hard or large. An anal fissure can cause an individual to experience a combination of pain, bleeding, and discomfort while trying to defecate. While anal fissures can happen to anyone and are commonplace, practicing timely care and proper management will help in healing and preventing the fissures from happening again.

Are anal fissures common?

Certainly, fissures are benign or shallow cuts in the skin surrounding the anus, also known as the anal mucosa. Anal fissures strike people of any age, even infants, and are usually caused by straining during a bowel movement, lengthy bouts of constipation, or passing hard-shaped stools. Although a large number of fissures tend to heal spontaneously, chronic and recurrent fissures demand proper care and fissure treatment options timely to avoid further complications.

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What are the symptoms of an anal fissure?

One can identify the symptoms of anal fissure, and they can have severe discomfort while diagnosing the symptoms in the toilet, the first symptoms are:

Pain during bowel movements: The duration has the symptom and is noticeable and this happens when you empty the bowel, you experience a burning, sharp or even a tearing sensation. It is commonly known as an anal …
Bleeding: The anal leakage occurs when the anal lining has been torn. In this case the anal lining happens to be torn.
Itching or Irritation: The anal opening has symptoms such as redness, inﬂamed skin which leads to continuous scratching.
Visible Tear: In the more severe cases, a visible crack or tear appears on the skin around the anal opening.
Spasms: The torn skin and muscle are exposed and act abnormally which means they are not functioning properly. In such cases, the healing process slows down and provides severe pain.
Sitting Pain: After spending a lot of time sitting, anal pain or discomfort may worsen.

How do I know if I have a hemorrhoid or an anal fissure?

While both affect the anal area and may cause pain or bleeding, fissures and hemorrhoids differ in their own characteristics, which help in their identification.

Pain Type and Timing: Anal fissures cause sharp, burning pain during and immediately after bowel movements, whereas hemorrhoids are associated with a persistent ache or throbbing, particularly when sitting down, and less sharp localized pain.
Bleeding Type: An anal fissure will often present with bright red blood on the stool or toilet paper. Hemorrhoid bleeding may appear during bowel movement, usually noted as an obvious blood clot or as a “coat” of blood around the stool.
Location: Most anal fissures occur on the posterior portion of the anal canal and most take place at the midline. Hemorrhoids can occur externally, around the anus, or internally – within the rectum – where they can develop as prolapsing swellings.
Visible Signs: A fissure is open and often looks like a small lineal break in the skin around the anus. Swollen, dark blue lumps can point to an external hemorrhoid, and polyps may bulge outwards during periods when the anus is strained.
Associated Symptoms: With hemorrhoids, there is often a “fullness” feeling, as well as tenderness, swelling, and a need to itch. The pain with anal fissures can be made worse by the spasming muscle cuts of the sphincter in the anus.

What is the main cause of an anal fissure?

The main cause of an anal fissure is trauma to the anal canal, usually due to hard, dry, or large stool. Overall, conditions that cause chronic constipation include:

Frequent Straining while having a bowel movement: Pressure on the anal canal puts it in a position to be injured.
Diarrhea: With multiple episodes of loose or watery stool, the anal tissue can become damaged or irritated.
Child birth: Vaginal delivery can cause anal fissures due to increased pressure on the pelvis.
Anal intercourse or trauma: Trauma to the anal area will likely result in a fissure.
Other medical conditions: Trauma to the anal canal can be more easily caused by conditions such as Crohn’s or inflammatory bowel disease (IBD).

How are anal fissures diagnosed?

It is generally accepted that the assessment of medical history and symptoms are the first two steps in the course of an anal fissure diagnosis. The overall evaluations are aimed at determining:
Medical History: The doctor will ask about the patient’s bowel movements, bleeding, and pain, and any relation to past anal, or gastrointestinal dysfunction.
Physical Exam: In most cases, a fissure can be seen visually, especially when the fissure is in the midline in the anal area.
Digital Rectal Exam: In some cases the doctor may require a brief anus examination with a single-gloved finger to determine whether deeper anal fissures are present, and if any further complications exist.
Further Tests: If fissures are recurrent, chronic, or unusual, then the physician may recommend tests such as an anoscopy or sigmoidoscopy, or other tests to exclude diseases such as Crohn’s.

What is the medical treatment for anal fissures?

The goal of medical treatment for anal fissures is to control pain, facilitate healing, and prevent further episodes from occurring. These goals can be approached using the following treatment methods:

Topical Medications: Prescription creams or ointments combined with nitroglycerin, calcium channel blockers (diltiazem), or corticosteroids relax the anal sphincter and improve blood flow, which helps with healing.
Pain Relief:Mild painkillers such as paracetamol or ibuprofen can be used to alleviate pain during defecation.
Stool Softeners:Use of fibre supplements or stool softeners prevents straining and the passage of hard stools, thereby preventing further injury to the anal skin.
Sitz Baths: Warm water baths to the anal area multiple times daily help alleviate pain, encourage the muscles to relax, and improve blood circulation to help you heal faster.
Botox injections: botulinum toxin is injected into the anal sphincter to temporarily relax the muscle and allow healing of fissures.
Surgical Intervention: when all have failed with chronic, non-healing fissures a lateral internal sphincterotomy can be performed to relieve the pressure in the anal sphincter allowing it to close.

What can I do to prevent anal fissures?

Prevention of anal fissures requires the safe guarding of the anal lining and good bowel and anal habits. These are the steps to be taken to reduce the risk:

Have Soft Stools: Eat a high-fibre diet with plenty of fruits, vegetables, and whole grains, and stay hydrated to prevent constipation and straining.
Don’t Strain: Straining with a bowel movement can dramatically increase your chance of fissures.
Establish Good Toilet Habits: Always heed the urge to have a bowel movement without delay, and eliminate the pre-cursors to a bowel movement and do not spend unnecessary time on the toilet.
Use Stool Softeners When Indicated: In most cases, stool softeners or fibre supplements can help to soften the stool in patients who normally have hard stool.
Maintain Anal Hygiene: After use, anal area must also be gently cleaned to avoid irritation and infection.
Control Fissure-Predisposing Conditions: Conditions like inflammatory bowel disease, or other chronic diarrheas or abdominal conditions should be managed properly.

Conclusion

An anal fissure is a small tear near the anus that can make bowel movements painful and result in bleeding and irritation. Effective and quick healing is possible with an understanding of fissures, the ability to identify fissure symptoms, knowledge of fissure causes, and seeking treatment in time.

An anal fissure is part of a Gastroenterology and Proctology concern and requires fissure care for proper diagnosis and treatment. With cutting-edge medical and surgical procedures, Rungta Hospital offers specialized care for anal fissures, helping patients find relief and prevent recurrence.