Anal fissure
What is Anal Fissure?
Anal fissure is a sore on the skin of the anus. In the majority of cases it is caused by local injury to the area.
Such injuries may include:
- Passage of hard stools due to constipation.
- Severe and persistent diarrhea.
- Anal Sexual contacts.
- After a natural birth (birth without caesarean section).
There are other rarer causes of rectal fissures, related to more serious conditions. Such examples are:
- Infectious diseases such as HIV, syphilis, chlamydia.
- Autoimmune bowel diseases such as Crohn's disease.
- Malignancy (precancerous or cancerous lesions).
An anal fissure is a fissure in the inner part of the anus. Most often, anal fissures heal with conservative means, while in persistent cases, surgical and non-surgical methods are used.
Anal Fissure or Hemorrhoid
Anal fissures are often confused with hemorrhoids, which are inflamed blood vessels inside or outside the anus.
Common elements of both conditions are that they are usually caused by severe constipation and present similar symptoms.
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Many times patients come to the doctor's office complaining of hemorrhoids and end up suffering from anal fissures.Causes
The most common causes of anal fissures are due to injury to the anal mucosa and are as follows:
- Persistent constipation and the passage of hard stools.
- Severe diarrhea.
- Anal sexual intercourse.
- Normal childbirth.
The most common causes of anal fissures are due to injury to the anal mucosa and are as follows:
- Inflammatory bowel diseases, such as Crohn's disease.
- Rectal cancer.
- HIV.
- Tuberculosis.
- Syphilis.
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Who is affected by Anal Fissure?
Anal fissures affect men and women of all ages, and are very common among infants. In general, it seems that anal fissures are more common in people under the age of 40. Susceptibility to anal fissures usually decreases with age.
Symptoms
In the acute phase, anal fissure is perceived as a sharp stabbing pain in the anus area.
The pain can become extremely severe during a bowel movement and last for several hours afterwards. In addition to pain, blood loss can occur (blood in the pelvis after defecation or blood on the toilet paper).
More rarely in rectal fissures, the only symptom may be a strong itching sensation in the area.
In the chronic phase, the pain is milder. The main symptoms here too are pain especially during defecation and blood loss. Stretch marks can also be noticed as a “pimple” in the area.
Recalling the main symptoms of anal fissures are:
- Sharp pain during bowel movements, which can last from a few minutes to several hours.
- The bright red color during or after a bowel movement.
- A small skin bump or a visible crack in the area, especially when the condition has become chronic or lasts more than 6 weeks.
Symptoms of the acute phase for anal fissures can last up to 2 months.Diagnosis
The diagnosis of anal fissure is most often based on taking a medical history and physical examination, with careful inspection of the area. However, because other medical conditions can cause similar symptoms to anal fissures, your doctor may also, depending on your age and medical history, recommend a rectaloscopy, sigmoidoscopy, or colonoscopy.
In the acute phase, proctoscopy is not recommended, due to the intense pain that accompanies it. In the second year, a proctoscopy is necessary to rule out other diseases of the anus (e.g. hemorrhoids).
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Most of the time anal fissures go away on their own, however, if treatment is needed there are a number of options your doctor may recommend.Therapy
The goal of treating anal fissures is to relax the anus to improve blood flow.
Anal fissure treatment is individualized and the options presented to the patient are a function of the severity of their symptoms.
Treatment usually begins with conservative measures and primarily by treating constipation through a high-fiber diet and adequate hydration.
The condition can also be helped by warm baths, which relieve and relax the area.
If deemed necessary, a doctor may also recommend medication, such as laxatives, stool softeners, painkillers, etc.
In the acute phase, creams are used that contain a substance that relaxes the area.
In case of particularly intense pain, the area can be additionally injected with botulinum toxin (e.g. dysport or botox).
Patients treated with Botox or Dysport have better results and fewer recurrences.
While in most cases anal fissures do not require surgery, in some, especially chronic conditions or when medical treatment does not work, surgery is the best option. The aim of the delicate surgery performed in the area is to relax the muscles of the sphincter which, in turn, reduces pain and allows the wound to heal.
In patients with a high suspicion of a sexually transmitted disease, the necessary workup must first be completed before treating the anal fissure.Read also...
Anal Fissure may return
Even after medical or surgical treatment, anal fissures can recur, so good bowel function and a high-fiber diet remain top priorities to prevent recurrences.
Complications
If an anal fissure remains untreated for a long time it can lead to complications such as:
- Stool wedging.
- Narrowing of the anal canal.
- Perianal fistula.
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Prevention
By eating a diet rich in fiber, keeping your body hydrated and following a regular exercise program, you can prevent constipation, and the straining during bowel movements that anal fissures can create.
Myths & Truths
Myth: Anal fissures affect the elderly.
Truth: Anal fissures affect people of all ages, especially infants.
Myth: Anal fissures need surgery.
Truth: No, anal fissures can be treated with conservative measures or drug therapy.
Myth: If I suffer from anal fissures, exercise is prohibited.
Truth: You can exercise if you have anal fissures depending on the severity of your symptoms.
Frequent Questions
Is surgery necessary to treat anal fissure?
The combination of topical medication (ointment) and botulinum toxin has largely obviated the need for surgery. However, in some, rarer cases, surgery is a good solution.
Is anal fissure linked to colon cancer?
No, anal fissure does not cause or develop into colon cancer.
Are there any preventative measures for anal fissures?
The most important preventive measure is to avoid injury to the area. The most common cause is constipation and the treatment includes enriching the diet with foods rich in plant fiber.
How long does anal fissure usually last?
Anal stretch marks last from a few days to a few weeks. Chronic anal fissures last more than 8 weeks.
How does the wound heal?
In order for wounds to close, they need good blood supply. In the places where the stretch marks appear, there is no good blood supply. The pain of the fissure causes spasm of the anus which in turn further reduces blood supply to the wound. In other words, a vicious circle is created.
Should I watch my diet while dealing with anal fissures?
A diet rich in fruits and vegetables, adequate hydration and avoiding spicy foods and nuts can help you while you have symptoms.