Anal Fissure

Table of Contents

What is Anal Fissure? 

An anal fissure is a small tear in the mucosa – a thin, moist tissue that lines the anus. This condition may occur when you pass hard or large stools during a bowel movement. Additionally, anal fissures usually cause pain and bleeding during bowel movements. You may also experience spasms in the ring of muscle at the end of the anus or anal sphincter

In most cases of anal fissures, the condition can improve with simple treatments, such as increasing your daily fiber intake or taking sitz baths. Anal fissures can heal in 4 to 6 weeks. If this disease persists for more than 8 weeks, it is considered a chronic condition.

Anal fissures are very common in infants but can affect people of all ages. Some people with anal fissures may need medication or occasionally surgery.

Causes of Anal Fissure

Be aware of what may cause anal fissures so that you can get proper treatment immediately. Common causes of anal fissures include:

  • Passing large or hard stools
  • Constipation and straining during bowel movements
  • Childbirth
  • Chronic diarrhea
  • Anal intercourse

Other less common causes of anal fissures include:

  • HIV
  • Syphilis
  • Tuberculosis
  • Anal cancer
  • Crohn’s disease or other inflammatory bowel diseases

Risks of Anal Fissure

There are several factors that can increase the risk of anal fissures, including:

  • Constipation – straining during bowel movements and passing hard stools increase the risk of tearing
  • Childbirth – anal fissures are more common in women after childbirth
  • Crohn’s disease – an inflammatory bowel disease that causes chronic inflammation of the intestinal tract, making the lining of the anal canal more vulnerable to tearing
  • Anal intercourse
  • Age – anal fissures can occur at any age but are more common in infants and middle-aged adults

When to See a Doctor for Anal Fissure

Consult a gastrointestinal surgeon through Smarter Health if you have symptoms of anal fissure.

Your doctor may ask questions about your medical history and perform a physical exam, including a gentle inspection of the anal region. Usually, this exam is all that is needed to diagnose an anal fissure.

Acute anal fissures look like new tears, whereas chronic anal fissures likely have deeper tears, and may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than 8 weeks.

The location of the fissure indicates its cause. A fissure that occurs on the side of the anal canal, not on the back or front, may be a sign of another disorder such as Crohn’s disease.

Your doctor may recommend further testing if he or she thinks that you have any underlying conditions. Possible tests may include: 

  • Anoscopy is a test done by inserting a special instrument into the anus to help your doctor visualize the rectum and anus.
  • Sigmoidoscopy is a test done to examine the end of the large intestine. Your doctor will insert a thin, flexible tube with a tiny video into the lower part of your colon.

These tests may be done if you are under age 50 and you do not have risk factors for colon disease or colon cancer.

  • Colonoscopy is a test done to detect sores, irritation, polyps, and colorectal cancer. Your doctor will insert a flexible tube into your rectum to examine the entire colon.

This test may be done if you are over the age of 50 years or if you have risk factors for colon cancer, underlying conditions, or other symptoms such as abdominal pain or diarrhea.

Anal Fissure Symptoms

Signs and symptoms of an anal fissure include:

  • Pain, sometimes severe, during bowel movements
  • Pain after bowel movements that can last up to several hours
  • A visible crack in the skin around the anus
  • A small lump appears near the anal fissure
  • Bright red blood on the stool or toilet paper after a bowel movement.

Consult your doctor immediately if you experience pain during bowel movements or notice blood in the stool or toilet paper after a bowel movement.

Anal Fissure Treatment

An anal fissure can usually resolve within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids.

If your symptoms persist, you may require further treatment.

Soaking in warm water for 10 to 20 minutes several times a day, especially after a bowel movement, can help relax the sphincter muscles and speed up the healing process

Non-surgical Treatments

Treatment options for an anal fissure may include: 

  • Externally applied nitroglycerin (Rektiv) is used to help increase blood flow to the fissure and help relax the anal sphincter. Nitroglycerin is likely recommended when other conservative measures fail. 
  • Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) can help relieve pain.
  • Botox injection is used to paralyze the anal sphincter muscles and relax spasms.
  • Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is ineffective or does not cause significant side effects.

Surgical Treatments 

If you have a chronic anal fissure that is resistant to other treatments or if your symptoms are severe, your doctor may recommend surgery.

Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing.

Studies have found that for chronic fissures, surgery has greater efficiency than any medical treatment. However, surgery carries the risk of incontinence or difficulty holding back bowel movements.

Treatment Cost for Anal Fissure

Treatment cost for anal fissures surgically is more expensive compared to non-surgery method. Surgical treatment for an anal fissure  is more expensive compared to non-surgery method. This may include the cost of surgery, hospital stay, medications, etc.

To calculate the estimated cost for an anal fissure treatment at home and abroad, contact Smarter Health.

Prevention

Anal fissures are not always preventable, but you can reduce the risk by taking the following precautions:

  • Drink plenty of fluids
  • Treat diarrhea promptly 
  • Change the baby’s diaper frequently
  • Keep the anal region dry
  • Eat fibrous foods
  • Exercise regularly to avoid constipation
  • Clean the anal area gently with soap and warm water

Home Remedies for Anal Fissure

Most anal fissures usually do not require extensive treatment. However, certain home remedies can help speed up recovery and relieve uncomfortable symptoms. You can treat anal fissures at home by:

  • Taking over-the-counter laxatives
  • Drinking more fluids
  • Taking fiber supplements and eating more fibrous foods, such as fruits and vegetables
  • Sitz bath to relax the anorectal muscles, relieve irritation, and increase blood flow to the anorectal region
  • Applying nitroglycerin ointment to increase blood flow to the area or hydrocortisone cream to help relieve inflammation
  • Applying a topical pain reliever to the anus to relieve discomfort

If your symptoms do not improve after 2 weeks of treatment, it is best to see your doctor for further evaluation. Your doctor may recommend other treatments.

Book an appointment with a gastrointestinal surgeon at home and abroad via Smarter Health if you have symptoms of an anal fissure. Smarter Health‘s online consultation (teleconsultation) service allows you to get medical treatments whenever you need them without leaving the house – thus minimizing the spread of COVID-19.

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