Anal fissure

Anal fissure refers to a slight tear or cuts in the thin, moist tissue (mucosa) lining the anus. If you pass through large or hard stools during a bowel movement, an anal fissure can form. Pressure and bleeding associated with bowel movements are the common indications of anal fissure. Spasms in the muscle ring at the end of the anus are also possible (anal sphincter).

Typically, anal fissure is more common in children, but they can as well occur to anyone at any age. Simple remedies, like increasing fiber intake and sitz baths, can help with the healing of the most anal fissure. However, an anal fissure can sometimes require medication or surgery in rare cases.

Signs and Symptoms of Anal Fissure

An anal fissure can lead to one or more symptoms such as;

A noticeable tear on the skin surrounding the anus
A sudden pain around the anal region, especially during bowel movements
A minute lump on the skin or a skin tag near the anal tear
Blood streaks on the stool or the toilet paper following bowel movements
Itchiness or burning around the anal region

Causes of Anal Fissure

The most common cause of an anal fissure is passing hard or large stools. Severe constipation or persistent diarrhea can damage the skin surrounding the anus. Other possible causes of anal fissure can include the following:

Too much straining during bowel movements or at childbirth
Inflammatory bowel disease (IBD), including Crohn's disease
Reduced flow of blood to the anorectal region
Anal sphincter muscles that are abnormally tight or spastic

An anal fissure can also occur due to the following reasons in rare situations;

Having HIV
Anal cancer
Syphilis
Tuberculosis
Herpes

Risk Factors of Anal Fissure

The following factors can increase the likelihood of getting an anal fissure;

Constipation: Tearing is more likely when you strain during bowel motions or pass firm stools.

Age: Although an anal fissure can develop at any age, they are most prevalent among infants as well as middle-aged adults.

Childbirth: Women are more likely to develop an anal fissure after giving birth.

Crohn's disease: An irritable bowel disease that triggers persistent inflammation of the intestinal system. It can cause the anal canal lining to more susceptible to tearing.

Anal intercourse: Engaging in anal intercourse can sometimes cause a fissure.

Anal Fissure Diagnosis

During diagnosis, the doctor is most likely to inquire about your previous medical history. They will also do a physical test, which will likely include a mild examination of the anal area. The tear is frequently noticeable. Therefore, this examination is typically all that is required to identify an anal fissure.

An acute anal fissure has the appearance of a fresh rip, similar to a paper cut. On the other hand, a chronic anal fissure is more likely to have a deep cut and fleshy growth inside or outside the region. When an anal fissure lasts longer than 8 weeks, then it is considered a chronic condition.

The location of the fissure reveals more about the underlying cause. A fissure on the side of the anal orifice, instead of the rear or front, is most likely to indicate the presence of another ailment, like Crohn's disease. If the doctor suspects you have another underlying illness, he or she may suggest additional testing such as;

Anoscopy: This involves the use of an anoscope. This is a tube placed into the anus to allow the doctor to see both anus and the rectum.

Colonoscopy: To evaluate your entire colon, the doctor will put an elastic tube into the rectum. If you're over 50, are at a high risk of colon cancer, or have signs and symptoms of other illnesses, including diarrhea and abdominal pain, this test may be recommended.

Flexible sigmoidoscopy: This test involves inserting a thin, flexible tube attached to a small video camera in the bottom region of the colon. If you are under 50 and don't have any risk for intestinal disorder or colon cancer, you may be eligible for this test.

Anal Fissure Treatment

By taking the necessary precautions to maintain your stool soft, like increasing fiber and fluid intake, an anal fissure can heal in a few days or weeks. Also, soaking for 10 to 20 minutes in warm water many times per day, particularly following bowel movements, could help relax your sphincter and hasten recovery.

In case the fissure symptoms don't go away, you will probably require additional anal fissure treatment.

Nonsurgical options:

The medical provider can recommend non-surgical treatment options such as;

Nitroglycerin applied externally to enhance blood circulation to the fissure and facilitate healing, as well as relaxing the anal sphincter. If all the conservative procedures fail, nitroglycerin is normally regarded as the medical therapy of choice. One of the most common side effects is an intense headache.
For anal fissure pain relief, topical anesthetic creams, including lidocaine hydrochloride (Xylocaine), might be useful.
Botulinum toxin type A (Botox) injections help relax the spasms and paralyze the sphincter muscle of the anal area.
Blood pressure drugs, including oral nifedipine (Procardia) and diltiazem (Cardizem) to assist in relaxing the anal sphincter. If nitroglycerin is ineffective or produces significant adverse effects, these medicines can be given orally or used externally.
If there is too much inflammation or swelling surrounding the fissure, the doctor may recommend a lotion or ointment containing steroid medicine. Steroids can assist in minimizing swelling near a fissure by reducing inflammation. This may aid in the relief of any itchiness or soreness. However, it shouldn't be used for more than a week at a time.

Surgical options:

The doctor might consider surgery for people with a chronic anal fissure that is not responsive to previous therapies. It could also be an alternative to the more severe anal fissure symptoms. Physicians often perform a lateral internal sphincterotomy (LIS) operation, which includes cutting a tiny piece of the anal sphincter muscle to relieve pain, spasm and enhance recovery.

Some researchers state that surgical procedure is more effective for treating the chronic fissure, unlike the medical therapy options. On the other hand, it might be associated with a minor risk of leading to incontinence.

Preventing Constipation and Keeping the Stools Soft

Take plenty of liquids: Adults need to drink at least two liters of liquids (10 to 12 cups) every day. Most of the fluid will be passed out as urine. Still, some are excreted in the gut, softening the stools. Most liquids will suffice; though, alcoholic beverages might cause a loss of fluid in the body (dehydration), which is not ideal.

Toileting: If you have the urge to pass stools, do not ignore it. Some people tend to ignore this sensation and postpone going to the bathroom till later. This could lead to the formation of larger, firmer stools that are much harder to pass through later.

Fiber supplements and laxatives: When a high-fiber meal is not working as expected, try fiber supplements or bulking agents. These include ispaghula, bran, methylcellulose, and sterculia. Methylcellulose also aids in the softening of feces, making them simpler to pass. These can be purchased in pharmacies or obtained through a prescription. Sometimes a laxative like lactulose or a macrogol laxative is recommended.

Avoid using painkillers containing codeine: An example of such drugs is co-codamol, the most prevalent cause of constipation. In most cases, doctors recommend using paracetamol to help alleviate the discomfort from anal fissure.

Complications of Anal Fissure

Some of the complications that might be associated with anal fissure are;

A fissure that doesn’t heal: An anal fissure that does not heal in eight weeks is termed chronic and might require additional treatment.

Recurrence: If you have had an anal fissure before, you are more likely to develop another.

A rip that extends to the muscles around: An anal fissure that extends to the muscle ring that keeps the anus sealed (internal anal sphincter) can make the healing of the anal fissure more challenging. A fissure that is not healed can set off a vicious cycle of suffering. This may need the use of drugs or operations to relieve the pain and restore or eliminate the fissure.

Preventing Anal Fissure

Although one cannot easily avoid or prevent an anal fissure, you can lower your risk by taking the following precautions;

Maintaining the anal region dry always
Using a mild soap with warm water, carefully cleanse the anal region.
Avoiding constipation by drinking enough water, consuming fiber foods, and working out regularly.
Addressing diarrhea as soon as possible
Change the diapers of infants regularly

Conclusion

An anal fissure is a condition characterized by the tear of the anal lining or the anus canal. Sharp discomfort and little volumes of bright red blood during bowel movements are possible symptoms of a fissure. Skin tags might form in the area linked with a serious local infection if it turns into a chronic anal fissure.

Past anal surgeries, irritable or inflammatory bowel illness, local malignancies, or sexually transmitted illnesses are linked to an anal fissure. They can also develop as a result of situations that cause trauma to the area. They can include vaginal childbirth, anal intercourse, and passing hard stool.