An anal fissure or rectal fissure is a painful tear in the skin of the anus. Especially young and middle-aged people can suffer from it. Experiencing symptoms of discomfort, pain or bleeding around the anal area usually keep people from discussing the situation with their doctor. Ignoring the pain and unpleasant discussion does not make the health problem go away. Not all anal bleeding leads to serious health problems but it can cause a lot of pain or worsen if not treated. So let’s get past being uncomfortable and talk about anal fissures so that you can learn some basic facts and find the some of the answers you seek for a symptom you may be experiencing.
What is an anal fissure?
An anal fissure is a tear in the anus, usually located on the front or back of the anus and extends along the length of the anal cleft.
Symptoms of an anal fissure
An anal fissure causes pain just as a normal break or tear in the skin. In particular, a sharp pain can occur during or after the bowel movement. Moreover, one can also suffer a bit from blood loss.
What are the causes of an anal fissure?
An anal fissure can have various causes. Obstruction is a common cause. By blockage of the intestines, stool thickens and hardens, rendering pressure necessary to release the bowels. Due to the pressure, a tear or crack in the anus may occur. Because bowel movement is in these cases painful, one will often unconsciously contain it. This will thicken the stool even more causing the fissure to open up again at each bowel movement. The problem thus remains.
Also, an increased tension or spasm of the sphincter can lead to anal fissures. Cramping causes a reduced blood flow, therefore the wound does not heal properly. Anal fissures are often observed in chronic inflammatory bowel disease – and particularly Crohn’s disease.
Diagnosing an anal fissure
The symptoms are often so clear that a diagnosis can be easily reached on the basis of a physical examination. It is therefore necessary for the doctor to examine the anus.
Treatments of an anal fissure
An anal fissure is generally easy to treat. By eliminating the main cause – hard stools – one can reduce the symptoms. It is important that the stool is kept soft. Eating enough vegetable fibers and drinking at least two liters of water per day are the best measures. Regular bowel movement prevents the stool to thicken and harden by being held up for too long.
A cramped sphincter can be relaxed by taking regular hot baths. It might also improve your blood circulation, causing the anal fissure to heal faster.
Ointments or suppositories are available for the treatment of anal fissures. A lidocaine ointment is prescribed regularly because it has a double effect: both anesthetic and analgesic. Zinc Ointments dry the skin and protect against moisture and feces. Ointments with isosorbide nitrate or diltiazem ensure the increase of blood supply to the anus, allowing the anal fissure to heal faster. However, these are only prescribed when the standard advice and ointments have no effect.
There are medications that soften the stool. Usually these are plant fibers that you can absorb as a drink or powder.
If the anal fissure is caused by spasm of the sphincter muscle, it can be treated by means of an injection of botulinum. This temporarily reduces the tension of the sphincter causing the contraction to disappear and it improves the blood flow. This may cure the fissure. After about three months the effect of the botulinum injection has worn off.
If the complaints persist and other treatments have no effect, an operation can be the course of action. However, this procedure is not often done anymore, because of possibly unpleasant complications, including incontinence. The surgical procedure for the treatment of anal fissures is done through an incision next to the anus that cuts the inner part of the sphincter muscle. As a result, the tension on the anal fissure is reduced allowing it to heal.
Preventing anal fissures
To avoid anal fissures it is important to keep the stool soft so you do not have to squeeze hard to lose it. This reduces the chances of developing anal fissures. In addition, existing fissures get a chance to heal.
The following tips will help to soften the stool:
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- Eat more fiber-rich foods such as green vegetables and whole grains. Fibers absorb moisture so that the stool remains soft. In addition, they stimulate bowel movements.
- Drink at least two liters of water per day. Drinking enough fluids is important to soften the stool.
- Exercise sufficiently. This stimulates the bowel movements.
- Go to the toilet when you feel pressure. Do not try to stop your bowel movements.
- Always have a good hygiene of the anus and the skin around it. Avoid perfumed or moist toilet paper but wash the anus after each bowel movement with warm water without soap. Pat the skin dry and wear cotton underwear that is not too tight.
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Last updated on July 13, 2016.