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.
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.
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.
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