Anal Fissure - Causes, Symptoms, Prevention & Treatments

Anal Fissure is a tear within the lining of the lower rectum (anal canal) that causes pain during bowel movements. Anal Fissure is a common problem that affects people of all ages, especially young and otherwise healthy people.

Most anal fissures heal with home treatment after a couple of days. If otherwise, do consult a health professional.

What is Anal Fissure?

Anal Fissure is a painful rupture of the anal canal. It is a small tear in the thin, moist tissue (mucosa) that lines the anus. This may occur once you pass hard or large stools during a bowel movement.

An Anal Fissure typically causes pain and bleeding during bowel movements. You may further experience spasms within the ring of muscle at the top of your anus (anal sphincter).

What is the difference between Anal Fissure, Anal Fistula, and Piles?

Anal Fistula is simply an abnormal connection between the anal canal and the skin surrounding the anus. On the contrary, anal fissure forms as a result of abnormal and hard bowel movements. It’s usually a tear that extends from the anal muscles to the anal canal.

Although anal fissures and fistulas arise as a consequence of different conditions, both of them show similar signs and symptoms. They are equally disturbing and painful.

Pile, also known as Haemorrhoid, is the development of swollen veins in the anus and lower rectum region. The main reason behind the development of pile is probably excessive straining during bowel movement. However, anal fissure is a thin tear in the anal mucosa that arise due to chronic constipation.

Although both pile and anal fissure affect the rectum area, both conditions are entirely different form each other.

How Common and Dangerous is Anal Fissure?

An anal fissure is quite common. Every 1 in 5 persons develops an anal fissure at least once in their lifetime. Every 1 in 350 adults suffers from painful episodes of anal fissure.

Anal Fissure is often not considered to be fatal and can be effectively treated with simple home remedies. However, an untreated anal fissure can turn chronic which can be deadly.

It can give rise to persistent pain. An early diagnosis and adequate preventive measures are the only possible ways to combat the painful episodes of anal fissure.

What are the Causes of Anal Fissure?

Anal Fissures are caused by injury or trauma to the anal canal – a tear on the skin around the anus. The most common causes of this injury include:

passing large or hard stools
chronic constipation or frequent diarrhea
straining during childbirth or bowel movements
anal intercourse
inflammatory bowel disease (IBD), such as Crohn's disease
overly tight or spastic anal sphincter muscles
decreased blood flow to the anorectal area

Some less common causes of anal fissure include:

Experts believe that extra tension within the two muscular rings (sphincters) controlling the anus could be the explanation for fissures. The outer ring is under conscious control while the inner ring is not, hence, under constant pressure. If the pressure upon the inner sphincter gets too much, it might cause spasms, thereby reducing blood flow which leads to an increase in the risk of an anal fissure

Signs And Symptoms of Anal Fissure?

Anal Fissure may cause one or more of the following symptoms:

skin irritation (burning or itching) in the anal area (anus) during or after bowel movements
sharp pain in the anal area during and after bowel movements
streaks of blood on stools or on toilet paper after wiping
bleeding during defecation
noticeable tear in the skin around the anus
a small amount of mucus in the stool
swelling and redness around the anal region
formation of a small lump or skin tag next to the tear in the anus area

Risk Factors for Anal Fissure

There are different risk factors that lead to the development of an anal fissure.

Approximately 10 percent of people are affected in their lifetime!

Constipation – Frequent experience or occurrence of constipation can increase the risk of having anal fissures. Straining during bowel movements and passing large, hard stools increase the risk of anal fissures.

Childbirth – Women, during and after childbirth, are at a higher risk for an anal fissure due to straining during delivery.

Anal Intercourse – Although less often, having anal sex or putting things into your anus can overstretch the skin and cause a fissure.

Age – Anal fissures can occur at any age, but are more common in infants and middle-aged adults. Older adults are prone to anal fissures due to decreased blood flow in the anorectal area.

Crohn’s Disease – This inflammatory bowel disease (IBD) causes chronic inflammation of the intestinal tract which can make the liner of the anal canal more susceptible to tearing.

Possible Complications of Anal Fissures

Anal Fissures don’t often give rise to any complication They can be properly managed with effective home treatment regimens. Nonetheless, if untreated, it could give rise to serious complications which include:

development of chronic anal fissures that don't heal. If it doesn't heal within eight weeks, you need further treatment
a recurrence of anal fissures. Once you've experienced a fissure, you're susceptible to having another
a tear that extends up to the surrounding (rectal) muscles giving rise to chronic pain episodes and discomfort whcih will require medications or surgery.

Diagnosis of Anal Fissure

After a physical examination of the anal area, the doctor is normally able to diagnose an anal fissure. If nothing is seen, gentle pressure exerted onto the anal area will often result in pain if there is an anal fissure.

Other ways to diagnose an anal fissure are:

Rectal Exam – involves inserting a small instrument or lubricated hand into the anus and examines the inner area. Most times, this is done by a specialist who applies anaesthesia to the area before a rectal exam because it may cause too much pain.

Anoscopy – involves the use of a special instrument inserted into the anus to examine the anal canal.

Sigmoidoscopy or Colonoscopy – involves using a rigid or flexible viewing tube to inspect inside the anus and rectum. This diagnostic test may be conducted if a mere serious disease of the anus is to be ruled out by the doctor.

Treatment of Anal Fissure

In most cases, anal fissures resolve themselves within a few weeks and don’t require extensive treatment. Certain home remedies can help to heal and relieve symptoms of discomfort, burning, and pain. They include:

drinking more fluids, preferably water. Tip: drink at least, 8 glasses of water a day
taking fiber supplements and eating more fiber rich foods such as fruits and vegetables
applying topical pain relievers to the anus to ease discomfort
taking a warm (not too hot) or sitz bath helps relax the anal muscles, ease the pain, relieve irritation, and increase blood flow to the anorectal area
using over the counter stool softeners
applying a nitroglycerin ointment to promote blood flow to the area or a hydrocortisone cream to help with inflammation.

Adults should aim for at least 18 grams of fiber each day.

If symptoms persist after using home remedies, you should seek medical advice. about 9 out of 10 short term fissures heal with home treatment, and about 4 out of 10 long term anal fissures will heal after home treatment is employed.

Not all fissures will heal with just home remedies. If a fissure lasts for 8 to 12 weeks, consult your doctor.

Prevention of Anal Fissure

Anal Fissure can be prevented by following some basic measures/tips as follows:

drink plenty of fluids/liquids - remember that water is the best fluid
eat well-balanced diet, regularly eat fruits and vegetables, and foods that contain fiber
exercise regularly to avoid constipation. Stay well hydrated during and after exercise
avoid foods that may not easily digest such as nuts and popcorn
Use mild soap and warm water to gently cleanse the anal area
ensure you keep the anal area constantly dry
Don't avoid or delay having bowel movement. Knowing that it would hurt may cause you to be anxious, but, trying not to have bowel movements will only make constipation worse. Delay only amkes the stools larger and harder.
Avoid rough or perfumed toilet tissue, use baby wipes, moistened cloths or medicated pads to wash after a bowel movement
for infants, change diapers frequently
avoid straining and sitting on the toilet for a long time.
maintain good hygienic habits to avoid the onset of an infection in the anal tract. Alwyas practice and encourage healthy hand washing habits

Finally,

In most cases, anal fissures get resolved within a few weeks without the need for medical treatment or surgery. Simple treatments like increased fibre intake, sitz bath, more intake of water and fluids could assist in the recovery.

A primary anal fissure has no identifiable cause, while a secondary fissure has an identifiable cause. Anal fissures that last less than six weeks are known as acute anal fissures. Chronic anal fissures have symptoms for longer than six weeks.

Anal Fissures are not contagious and can not lead to colon cancer. Colon cancer is often misdiagnosed as an anal fissure because its symptoms and signs are similar to that of an anal fissure.

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