Anal Fissure

Overview

What is an Anal Fissure?

Most people have experienced a tear or fissure at the corner of the mouth that can occur in cold and dry weather or when yawning. Similarly, an anal fissure is a small tear in the lining of the anus that can occur with straining and a change in bowel habits. 

Causes

Fissures are usually caused by trauma to the inner lining of the anus. Trauma may be caused by:

  • Having tight anal sphincter muscles
  • Hard, dry bowel movements
  • Loose stools
  • Diarrhea
  • Abuse of laxatives
  • Injury during childbirth

Symptoms

Typically, an anal fissure includes the following symptoms:

  • Severe pain during and after a bowel movement, lasting up to a few hours
  • Blood from the anus that can be seen on the stool or toilet paper
  • Itching of the anus
  • Between bowel movements, affected individuals are usually symptom free

Diagnosis of Anal Fissure

A simple visual examination of the anus and surrounding tissue usually reveals the fissure. It is quite tender when examined by the physician. Fissures are most often located in the middle posterior (back) section of the anus.

Treatments

More than half of all fissures heal either by themselves or with non-surgical treatment. Stool softeners can help reduce pain during bowel movements and help the patient avoid constipation and straining. Antibiotics may be indicated in certain situations. Special medicated creams may also be used. It is important to keep the anus and area between the buttocks clean and dry. After bathing, the patient should gently pat dry with a soft towel. Sitz baths may help relieve discomfort and promote healing. A Sitz bath is soaking the anal area in lukewarm -- not hot -- water for 15-20 minutes several times a day.

If the fissure is not responding to treatment, the physician re-examines the patient. There are conditions, such as muscle spasm or scarring, which could interfere with the healing process. Fissures that do not heal can be corrected with surgery. It is a minor operation that is usually done on an outpatient basis. The surgeon removes the fissure and any underlying scar tissue. Cutting a small portion of the anal muscle prevents spasm.

This helps the area to heal and rarely interferes with the control of bowel movements. Complete healing takes place in a few weeks. However, the pain often disappears after a few days.

Over 90% of the patients who need surgery for fissures have no further problems. Patients can help avoid the return of fissures by drinking at least eight glasses of water a day, and maintaining adequate fiber in the diet. This prevents constipation, which can lead to the development of most fissures.

Resources

American Society of Colon & Rectal Surgeons

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