Anal fissure Treatment, Symptoms & More
What is an Anal fissure?
An anal fissure refers to a small tear or cut on the fragile lining surrounding your anus. This tear commonly occurs due to passage of hard stools, constipation or persistent diarrhoea. Although anal fissures are not serious conditions, they can affect people of all age groups, causing pain and bleeding during bowel movements. Majority of anal fissures heal on their own within a period of four to six weeks, some require simple treatments, and surgery may be indicated in few cases.
Signs and Anal fissures symptoms
Some common signs and symptoms of anal fissures include:
- A clearly visible skin tear around the anus
- Sharp pain during bowel movements
- Presence of blood in stools or on toilet paper
- Visible skin tag or lump on the skin around the anal region
- Pain that is sometimes severe, lasting for several hours
- Itching or burning sensation in and around the anal region
Causes of Anal fissures
Anal fissures generally occur as a result of excessive pressure, trauma or injury to the anal canal.
Below are some common causes of anal fissures:
- Chronic constipation
- Persistent diarrhoea
- Strain during bowel movements
- Excreting hard or large stools
- Excessive straining during childbirth
- Trauma during anal sex
- Extremely tight sphincter muscles (muscles of the anus)
- Decreased blood flow to the anus
Other medical conditions associated with anal fissures include:
- Inflammatory bowel diseases
- Sexually transmitted diseases
- Anal cancer
Risks associated with Anal fissures
Anal fissures, if left untreated for a long period of time can lead to several complications, including:
- Chronic anal fissure: Anal fissures failing to heal within a period of eight weeks are considered to be chronic and may lead to extensive scar tissue in the anal region.
- Recurring anal fissures: Once an anal fissure occurs, there are always increased chances of experiencing repeated anal fissures.
- Extension of the anal tear: An anal fissure may extend to the surrounding muscles of the anus (internal anal sphincter), which makes the healing process more challenging.
Diagnosis of Anal fissures
Anal fissures are diagnosed based on your symptoms, medical history and physical examination. Your doctor may perform an anal and rectal examination using an anoscope to confirm the diagnosis. An anoscope is a thin tube-like medical instrument inserted into your rectum for clear visualization of the tear and inspection of the anal canal.
In case your doctor suspects any underlying conditions associated with your anal fissures then further testing is done.
Anal fissure Treatment
The main aim of anal fissure treatment is to relieve pressure on the anal canal by softening stools to reduce bleeding and discomfort. Some simple conservative treatment methods include:
- A diet containing more fibres and fluids and limiting caffeine consumption to help soften stools.
- Relaxation of anal muscles through sitz bath (soaking in warm water) for 10-20 minutes, several times in a day.
- Local application of anaesthetic gel and creams which relieves spasm in the anorectal area.
These simple methods usually heal 90% of anal fissures within few weeks to months, however if the signs and symptoms still persist, injections may be used to relax the anal muscles and promote healing. Surgery is considered as the final option if none of the conservative and medical treatments have healed the fissure.
Surgery for anal fissure may include the following:
Sphincterotomy- This surgery involves cutting the sphincter muscles of the anus, to help it relax. Also called lateral internal sphincterotomy, it is the most common procedure to treat anal fissures.
Fissurectomy- This surgery is less common and involves surgical removal of the edges of the fissure and cauterization of the area, to relive pain and bleeding.
Frequently asked questions (FAQs): Anal Fissure
How can I lower my risk of anal fissures?
You may lower your risk of anal fissures by following a diet rich in fibre, drinking more fluids, and exercising regularly, which allow for easy bowel movements and prevention of constipation and diarrhoea.
What happens if a fissure goes untreated?
If a fissure goes untreated it may lead to complications such as extensive scar tissue around the fissure, recurring fissures and extension of the anal tear into surrounding muscles causing severe pain and discomfort.
What are the treatments for anal fissures?
Treatments for anal fissures include conservative methods such as sitz bath, a fibre-rich diet, regular exercises, and medications to relax the anal muscles and relieve pain. In some cases where conservative methods and medications fail to heal the anal fissure, surgery is indicated.
If you are constantly experiencing pain during and after bowel movements, with appearance of blood in your stools and on toilet paper, you must consult your doctor. Gleneagles Global Health City, Chennai has the best gastroenterologists and colorectal surgeons for expert medical treatment and surgical interventions. Fill out the enquiry form below to book your appointment now!
Dr Mahadevan B
HOD & Senior Consultant – Department of Gastroenterology & Endosonography