Anal fissure is a linear tear in the skin of the distal anal canal below the dentate line. Millions of people suffer from anal fissure by having painful bowel movements.
This condition is commonly experienced by young people but it can also be found in grown men and women. The usual symptoms include anal pain during or after a bowel movement. Another symptom is rectal bleeding, which is usually bright red in color. The pain can become so severe that it can take hours or a few minutes after defecation. Bleeding due to anal fissure does not usually come out in large amounts. Therefore, any blood from the area maybe from other sources like hemorrhoids, as both go hand in hand. Pruritus ani or commonly known as anal itching can also accompany anal fissure. As a result of anal fissure, the symptoms can cause discomfort and can impact negatively on the quality of someone’s life.
During a physical examination, the fissure may be visible in the anal canal as a pear-shaped split if the buttocks are parted. However, its view can sometimes be blocked by marked spasms of the anal canal. The diagnosis of anal fissure is often made possible by clinical evidence of the anal spasms and pain combined with proctoscopy or digital rectal examination. A visible anal fissure will have a granulation tissue on its base that has highly demarcated fresh mucosal edges. There will be a noticeable lack of granulation tissue and induration of the margins of the anal fissure if chronicity is increased. A number of characteristics will be noticeable in the case of anal fissure. They include:
- presence of horizontal fibers of the internal sphincter muscle at the base of the mucosal defect
- changes of sentinel skin tag
- presence of an anal stenosis
Anal Fissures Facts
- Anal fissures are determined by visual examination of both the anus and anal canal.
- The primary symptom of an anal fissure is pain following bowel movements. Aside from a painful defecation, malodorous discharge, itching, and bleeding are other symptoms of anal fissures.
- Basically, anal fissures are tears in both the anus and anal canal, which may be chronic or acute.
- The main cause of anal fissures is trauma. However, if fissures are present in rare locations, they should be detected since various non-traumatic diseases are related to anal fissures.
There are both home remedies and over-the-counter products that can be used to treat anal fissures. Some home solutions include:
- having a sitz bath
- changing your diet to foods that have high fiber content, which soften the stool
- drinking an adequate amount of fluids
If these home solutions fail to work, prescription drugs may be used such as:
- calcium channel blockers
- ointments that contain anesthetics
The most reliable or rather efficient treatment for anal fissures is a surgical procedure known as lateral internal sphincterotomy. However, surgery only becomes an option when non-surgical treatments are ineffective.
Causes of Anal Fissure
Anal fissures are mainly caused by trauma in the lining of the anus. Unfortunately, patients with a tight and increased muscle tone, have a higher risk of getting anal fissures. The primary cause of anal fissures is hard and dry stools. Moreover, stool and diarrhea can also be the cause.
Due to pain caused by bowel movements, spasms can be produced in the anal sphincter muscles, hence, a reduction in the blood flow that eventually causes impaired healing of the affected wounds. More bowel movements can cause more pain and decrease in blood flow. The treatments for this condition aim at getting rid of such cycle, relaxing the anal muscle to efficiently heal the wound.
Inflammatory conditions and some infections in the anus are a few of the other causes of anal fissures.
Risk Factors and How to Lower Them
- Constipation - is a result of straining in the bathroom due to a hard stool, which usually causes too much strain to the anal canal leading to tears. It can be solved by taking plenty of fluids that can help soften the stool and avoid constipation. Taking an over-the-counter stool softener is another way of avoiding constipation. It is mostly advised to mothers who just gave birth.
- Diarrhea - is clearly different from constipation. However, any changes in the bowel movement can create stress in the body, which in turn puts fissures at a higher level. This condition happens mostly to people who frequently travel and end up changing their diets. Changing your diet puts the digestive system to the test.
- Childbirth - comes with stress on the body tissues, and muscles can also lead to fissures. This situation can be avoided by taking lots of foods that are highly enriched with fiber and leafy greens. Lean meats and fish are preferable to red meat for protein purposes. It’s advisable not to get rid of all fat from your diet since oil and fat are good lubricants that help the digestive system to work properly.
Symptoms of Anal Fissure
- Severe pain - especially during and after bowel movements. It usually takes a few minutes but may further extend to hours.
- Bleeding - after straining in your bowel movement, bright red blood might be seen in your stool.
Surgery for Anal Fissure
For outpatients, surgery involves a Botox injection into the anal sphincter and the separation of some parts of the internal anal sphincter. The main goal of surgery is to relieve pain in the anal muscles. Thus, doing away with the anal spasm and letting the fissure to heal.
Injecting Botox heals about 50 to 80 percent, while sphincterotomy heals around 90% of the patients. Regardless of how successful the surgery is, these procedures come with risks. You should discuss with your surgeon about the risks together with the required treatment of your anal fissure.
Treatment for Anal Fissures
Surgery is usually not necessary in most cases of anal fissures. Including a lot of fiber in your diet and increasing your water intake can be effective ways of getting rid of anal fissures. Having warm baths that can last for about 10 to 20 minutes can be good in soothing and relaxing the anal muscles. You can also use topical anesthesia to ease the pain.
Other medications such as nifedipine gels, nitroglycerin ointments, and diltiazem creams can also be effective in relaxing the anal sphincters. However, surgical treatment may be required in the case of chronic fissures.
Anal Surgical Stretch for Anal Fissures
There are a number of procedures used by surgeons to treat anal fissures and they involve stretching and tearing of the anal sphincters. Even though anal stretching has turned out to be effective in alleviating pain, in most cases, it involves uncontrolled and traumatic disruption of the anal sphincter. Sometimes, the trauma in the anal sphincter extends beyond the desired area, which often leads to stool incontinence. It has also worked in only 72 percent of anal fissure cases. For this reason, it has fallen out of favor.
How long is the recovery process?
It can take up to 6 to 10 weeks for a person to completely recover from the surgery. However, it only takes a few days for the pain to go away. In most cases, patients can go on with their daily activities in just a few days after the surgery.
- The main cause of anal fissures is trauma.
- The most reliable or rather efficient treatment for anal fissures is a surgical procedure known as lateral internal sphincterotomy.
- Surgery only becomes an option when non-surgical treatments are ineffective.