Anal Fissure

1 What is Anal Fissure?

Anal fissure is a small crack or tear in the moist lining of the anal canal.

Anal fissures may be acute or chronic and cause pain during and after bowel movement.

Pain and rectal bleeding are the most common symptoms of anal fissures.

The lining may tear when large, or hard stool pass through the anal canal. It is common in small children, but may develop at any age.

Anal fissures can be controlled by having a diet high on fibers.

Most cases of anal fissures resolve within six weeks. If anal fissures are not corrected with conventional or home remedies, medications and surgery are suggested. 

2 Symptoms

Pain that worsens during and after a bowel movement is the most common symptom of anal fissure.

  • The pain may last up to several hours in some cases.
  • Blood on stool or toilet paper indicates rectal bleeding.
  • Physical examination reveals the presence of a visible tear around the anus.

Anal fissures are also characterized by itching or burning in the anal area. In most cases skin tags are present near the fissure.

When the pain is severe, patient may be unwilling to have bowel movement. This may lead to constipation or fecal impaction.

Pain may also affect urination, leading to discomfort or inability to urinate. Discharge of pus from the fissure causes malodorous discharge from the rectum. 

3 Causes

Trauma to the anal canal is the most common cause of anal fissure. Trauma is caused by passing hard and large stools.

Some other common causes of anal fissures are

Anal cancer, HIV infection, tuberculosis, syphilis, and herpes are also possible causes of anal fissures.

Most common risk factors for developing anal fissures are age, constipation, childbirth, Crohn’s disease, and anal intercourse.

Many children develop fissures in their first year. Many older adults also develop tear in the anal canal due reduced circulation to the area.

4 Making a Diagnosis

Physical examination is the tried and tested way to diagnose anal fissures.

Anoscopy, a procedure in which a short tube called anoscope is introduced into the anal canal and rectum, also helps to locate the anal fissure. Location of the fissure reveals the actual cause of the condition.

Crohn’s disease results in anal fissures on the sides of the anus. In patients younger than 50 years, sigmoidoscopy is suggested.

In this method, the distal part of the colon is examined. For patients above 50 years and those who have high risk of developing anal fissures, full colonoscopy is recommended. 

5 Treatment

In most of the cases, anal fissures do not require any specific treatment. The symptoms resolve on their own within 4-6 weeks. Having food rich in fiber and fluid helps make the stool soft. Sitting in warm water for around 15 minutes several times a day helps to promote healing. Treatment is suggested if symptoms persist.

Topical application of nitroglycerine increases blood flow to the anal canal region, and improves healing of the lining. Topical anesthetic creams are suggested to relieve pain. Botox injections are used in some cases to alleviate spasms of the anal sphincter. Medications like nifedipine and diltiazem also helps to relax anal sphincters for easy passage of stool.

Chronic form of anal fissure that does not respond to standard treatment methods may need surgery. Lateral internal sphincterotomy is a surgical procedure in which a small portion of the anal sphincter muscle is cut to reduce spasm. It also helps to reduce pain during bowel movements.

Fissures caused by underlying diseases like tuberculosis, HIV, or rectal cancer may not heal with standard treatment methods. Treating the underlying condition is the best way to control the symptoms.

6 Prevention

One can reduce the risk of getting anal fissures by taking adequate preventive measures.

In infants, changing diapers often helps to prevent fissures and rectal bleeding.

Drinking plenty of water and eating fibrous foods help to improve bowel movement.

Regular exercise also helps to have smooth bowel movements.

Treating diarrhea immediately is also important. 

7 Alternative and Homeopathic Remedies

Graphite is a common homeopathic remedy used to control symptoms of anal fissure like constipation and hard stools.

Nitric acid is used to alleviate rectal bleeding after bowel movements.

Ratanhia and phosphorous help to reduce pain, while paeonia prevents malodorous discharge.

Olive oil, aloe vera, comfrey, coconut oil, L-arginine gel are the common home remedies used to reduce the impact of symptoms. 

8 Lifestyle and Coping

There are different ways to adapt your lifestyle in coping with anal fissure.

Adding more fiber to diet helps to soften the stool and makes bowel movements less painful.

Drinking adequate fluid also helps to prevent constipation. Exercising regularly improves bowel movements. 

9 Risk and Complications

Chronic form of anal fissure is a possible complication of anal fissures.

There are chances of recurrence of anal fissures in some cases.

The tear in the lining of the anal canal may extend to the anal sphincters causing trouble in healing.