Anal fissures: causes, symptoms, diagnosis, treatment

What are Anal fissures?

Anal fissures are small tears or cuts in the skin lining the anus. The anus is the opening at the end of the rectum that allows stool to exit the body. Anal fissures can cause pain and bleeding during bowel movements, as well as itching and discharge.

Constipation or diarrhea, which can cause strain and trauma to the skin in the anus, are common causes of anal fissures. Childbirth, inflammatory bowel disease, and infection are all factors that may contribute to the development of anal fissures.

Medication to relax the muscles in the anus and promote healing, as well as dietary and bowel changes to soften stools and reduce strain during bowel movements, may be used to treat anal fissures. Surgery may be required in some cases to repair the fissure.

If you have persistent pain, bleeding, or other symptoms associated with anal fissures, you should seek medical attention.

Pain during bowel movements, bright red blood on the toilet paper or in the stool, itching or discharge around the anus, and the sensation of incomplete bowel movements are all symptoms of anal fissures. Anal fissures are frequently visible in the skin around the anus as small cuts or cracks.

Anal fissure treatment may include a combination of medications and lifestyle changes. Topical creams or ointments to relax the muscles in the anus and promote healing, as well as oral medications to soften stools and reduce strain during bowel movements, are examples of medications.

Increased fiber intake, increased fluid intake, and avoiding constipation by using the restroom as needed are examples of lifestyle changes.

Surgery may be required in some cases to repair the fissure. To relax the anal sphincter and promote healing, a small piece of muscle may be cut or removed.

If you have persistent pain, bleeding, or other symptoms associated with anal fissures, it is critical that you seek medical attention because these symptoms may indicate the presence of a more serious condition. Your doctor can determine the source of your symptoms and recommend appropriate treatment.

Symptoms

Pain during bowel movements is the most common symptom of anal fissures. This pain may be severe and may last for some time after the bowel movement is finished. Other signs of anal fissures include:

  • The presence of bright red blood on the toilet paper or in the stool
  • Itching or discharge in the vicinity of the anus
  • Feelings of incomplete bowel movements
  • Small cuts or cracks in the skin around the anus are visible.

If you are experiencing any of these symptoms, you should seek medical attention. They can assist you in determining the cause of your symptoms and recommending appropriate treatment. If you have persistent pain, bleeding, or other symptoms associated with anal fissures, it is critical that you seek medical attention because these symptoms may indicate the presence of a more serious condition.

Causes

Trauma to the skin lining the anus causes anal fissures. A variety of factors can contribute to this trauma, including:

  • Constipation: Straining to pass hard stools can cause anus trauma and the formation of anal fissures.
  • Diarrhea: Frequent, watery stools can also cause anus trauma and the formation of anal fissures.
  • Childbirth: The process of childbirth can cause anus trauma and the formation of anal fissures.
  • Inflammatory bowel disease (IBD): Conditions that cause inflammation in the digestive tract, such as Crohn’s disease and ulcerative colitis, can result in the formation of anal fissures.
  • Infections in the anus or rectum can also cause trauma and the formation of anal fissures.

Diagnosis 

A physical examination and a review of symptoms are usually used to diagnose anal fissures. A healthcare physician would often inspect the anus and rectum for obvious evidence of a fissure, such as a small rip or split in the skin, during a physical examination.

The healthcare practitioner may also inquire about particular symptoms such as bowel pain or discomfort, rectal bleeding, and itching or burning in the anus. Additional testing may be required in certain cases to confirm the diagnosis and rule out other illnesses that cause similar symptoms, such as hemorrhoids or inflammatory bowel disease (IBD). Among these tests are:

  • Digital rectal examination: A healthcare professional puts a gloved finger into the rectum to inspect the anus and rectum for abnormalities during a digital rectal examination.
  • Anoscopy: During an anoscopy, a healthcare worker inserts a tiny, illuminated device into the anus to look for abnormalities, such as a fissure.
  • Sigmoidoscopy: A sigmoidoscopy is a procedure in which a healthcare practitioner inserts a flexible tube with a camera on the end into the rectum and examines the bottom region of the colon for abnormalities.
  • Colonoscopy: A colonoscopy is a procedure in which a healthcare practitioner inserts a flexible tube with a camera on the end into the rectum and examines the whole colon for abnormalities.

Treatment

Anal fissure treatment may include a combination of medications and lifestyle changes. The following are some common treatments for anal fissures:

  • Topical creams or ointments: These medications can aid in the relaxation of anus muscles and the promotion of healing.
  • Oral medications: These medications can aid in the softening of stools and the reduction of strain during bowel movements.
  • Changes in your diet and bowel habits can help to prevent constipation and relieve strain during bowel movements. This may entail increasing fiber intake, increasing fluid intake, and avoiding constipation by using the restroom as needed.
  • Surgery may be required in some cases to repair the fissure. To relax the anal sphincter and promote healing, a small piece of muscle may be cut or removed.

It is critical to consult with a healthcare provider to determine the best treatment option for your specific situation. They can assist you in determining the cause of your symptoms and recommending appropriate treatment. 

Things to avoid for Anal fissures

You can help prevent the development or recurrence of anal fissures by doing the following:

  • Avoid straining during bowel movements: Straining to pass hard stools can cause anus trauma and the formation of anal fissures. It is critical to maintain good bowel habits and avoid constipation to avoid straining. This may entail increasing fiber intake, increasing fluid intake, and using the restroom when the urge to urinate arises.
  • Avoid diarrhea: Frequent, watery stools can also cause anus trauma and the formation of anal fissures. To avoid diarrhea, maintain a healthy diet and avoid foods and beverages that may cause diarrhea, such as those high in fat or caffeine.
  • Scratching or rubbing the anus can cause additional irritation and trauma to the skin, which can lead to the development or worsening of anal fissures.
  • Avoid using rough or abrasive toilet paper: Using rough or abrasive toilet paper can cause irritation and trauma to the skin around the anus. It is critical to use soft toilet paper that is gentle on the skin.
  • Avoid prolonged sitting: Prolonged sitting increases the risk of developing or worsening anal fissures. It is critical to get up and move around on a regular basis to promote good blood flow and prevent the formation or worsening of anal fissures.[1]9aa9295316ab226b-87a25cb7a893-94cdf10f02fd8eadf334aa40f90b20fb8e511ac3a0700a214889e5c6e3c7.pdf (nps.org.au)[2]cpg_for_the_management_of_anal_fissures_jan_2017_dcr_issue.pdf (fascrs.org)[3]https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/ColorectalandStomaCare/5148-2-Anal-Fissure.pdf

Reviewed by:

Dr. Amjad Hayyat

MBBS, FCPS

Medical specialist

Makhdoom medical complex, Sargodha, Pakistan

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