Anal Fissure: Symptoms, Causes, Risk factors, Diagnosis, Complication, Management and Prevention

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Anal fissure is small tear in the mucosal lining of anus. It may be due to passing of hard stool (as seen in constipation) which may lead to pain and bleeding and also sometimes spasm of anal sphincter. Anal fissure can occur to anybody (at any age and both sexes are affected), although it is common among infants. Anal fissure usually heals on its own within 4-6 weeks time. If it does not heal within 6 weeks medical attention should be sought.

What are the symptoms of anal fissure?

Signs and symptoms of anal fissure include:

  • Pain during defecation, which may be severe at times.
  • Bleeding during bowel movement, this may be seen on toilet paper or in stool.
  • Pain after bowel movement may last for several hours.
  • A tear or crack can be seen in and around anus
  • Irritation and itching in anal area
  • There may presence of skin tag or small lump/swelling near the crack on the skin

What can cause anal fissure?

Anal fissure can be caused by following:

  • Constipation, that generally leads to passing of hard and large stool. Constipation also lead to straining during bowel movement and lead to tear in the skin/mucosa around anus
  • Chronic diarrhea, this leads to passing of watery and acidic stool. Acidic content of watery stool cause erosion of anal mucosa. IBS (irritable bowel syndrome) can also cause anal fissure, especially in diarrhea predominant IBS.
  • Inflammatory bowel disease such as Crohn’s disease cause inflammation in anorectal area and lead to development of anal fissure
  • Childbirth is can also cause anal fissure
  • Less commonly anal fissure may be caused by HIV infection, tuberculosis, herpes, syphilis, human papilloma virus infection and anal cancer

What are the risk factors of developing anal fissure?

Risk factors of developing anal fissure include,

  • Infants are at high risk of developing anal fissure. The reason of high risk is not known.
  • Elderly individuals are also at higher risk of developing anal fissure. In elderly the cause most likely is reduced blood flow in anorectal region due to slowing down or weakening of circulatory system.
  • Constipation: this is the most important preventable cause of anal fissure. Straining and passing of large and hard stool by constipated person lead to tearing of skin and mucosa of anal area.
  • Anal fissures are common after childbirth among women.
  • Inflammatory bowel disease such as Crohn’s disease increase risk of developing anal fissure

What are possible complications of anal fissure?

Possible complications include,

  • Non-healing of anal fissure, despite optimal treatment/management
  • Recurrence after healing/cure of anal fissure is another common complication
  • Tear in skin and mucosa may extent to nearby muscles, especially to those muscles that hold the internal anal sphincter. This lead to failure to heal as well as there is risk of developing incontinence of stool due to weakening of internal anal sphincter.
  • Infection to the fissure/crack

Diagnosis of anal fissure:

Thorough physical examination is usually adequate to diagnose anal fissure. Sometimes, your doctor may perform digital rectal examination (insert two fingers inside your rectum), but it is usually avoided because it may be too painful.

However, your doctor may ask you to undergo certain tests such as colonoscopy, flexible sigmoidoscopy etc. These tests are helpful in finding out the possible cause of anal fissure.

What are the treatment options available for anal fissure?

The treatment options available for anal fissure include medical and surgical.

Anal fissures usually heal by itself within 4-6 weeks. However, some measures can speed up the healing process, such as increasing fiber and fluid intake (to make stool soft and prevent constipation), soaking in warm bath for 10 to 20 minutes after bowel movement. If these measures fail to heal anal fissure, you may require medications for treatment. These include,

  • Use of nitroglycerine externally to improve blood flow to the fissure area and improve healing and relax anal sphincter. This is commonly used treatment modality when conservative measures mentioned above fail.
  • Botulinum toxin injection to cause paralysis of anal sphincter muscles and relax spasm.
  • Steroid cream may relieve discomfort associated with anal fissure
  • Certain blood pressure medications (calcium channel blockers) can help relax anal sphincter and promote healing
  • Antiseptic solutions such as povidine iodine to prevent infection to fissure/crack/tear in mucosa and skin is also helpful in healing

Surgical option of management is used when medical management fails to heal anal fissure. Common surgical procedures include anal dilatation, lateral internal sphincterotomy etc. Surgical option is never first option for treatment of anal fissure and reserved for those, who did not respond to medical management.

Prevention of anal fissure:

Certain measures can help prevent anal fissure. Constipation is one of the common preventable causes of anal fissure. Hence, by preventing constipation it is possible to prevent anal fissure to certain extent (those caused or enhanced by constipation). Take foods rich in dietary fiber and take plenty of liquid and avoid straining during bowel movement. These measures can prevent constipation and help preventing anal fissure. Treat diarrhea promptly to prevent anal fissure caused by diarrhea. Doing regular exercise is also helpful in anal fissure. Regular exercise improve blood circulation in all parts of the body including anorectal region and exercise also help in promoting regular bowel movement, that is useful in anal fissure.

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1 Comment

  • Micheal February 09, 2017 01.12 am

    Arclites like this are an example of quick, helpful answers.

    Reply 

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