Overview
An anal fissure is a small tear in the thin, moist tissue that lines the anus, which is the muscular opening at the end of the digestive tract. Anal fissures typically cause pain and bleeding during bowel movements. Common causes include constipation, straining during bowel movements, or passing hard or large stools. Symptoms may include pain during and after bowel movements, bright red blood on stools or toilet paper, and a visible crack in the skin around the anus. If you experience these symptoms or notice blood on stools, it's recommended to see a health care provider. Anal fissures can usually be treated with increased fiber intake, warm-water baths, or medication, but sometimes surgery may be necessary.
Understanding the disease
Symptoms
The symptoms of an anal fissure include:
- Pain during bowel movements.
- Pain after bowel movements that can last up to several hours.
- Bright red blood on the stool or toilet paper after a bowel movement.
- A visible crack in the skin around the anus.
- A small lump or skin tag on the skin near the anal fissure. If you experience any of these symptoms, it's recommended to consult with your health care provider.
Risk Factors
Risk factors for developing an anal fissure may include:
- Constipation: Straining during bowel movements and passing hard stools increase the risk of tearing.
- Childbirth: Anal fissures are more common in women after they give birth.
- Crohn's disease: This inflammatory bowel disease 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.
Development
Anal fissures develop when there is a small tear in the thin, moist tissue that lines the anus. Common causes include constipation, straining during bowel movements, and passing hard or large stools. Other factors that may increase the risk of developing an anal fissure include childbirth, Crohn's disease, and anal intercourse. Once an anal fissure develops, it can cause pain and bleeding with bowel movements, as well as spasms in the anal sphincter muscle. If left untreated, complications such as failure to heal or recurrence may occur.
Assessment and Diagnosis
Triage
You should see a doctor if you suspect an anal fissure if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.
Diagnosis
Your health care provider will likely diagnose an anal fissure by asking about your medical history and performing a physical exam, including a gentle inspection of the anal region. The tear may be visible, and usually, this exam is all that's needed to diagnose an anal fissure. If the fissure is acute, it may look like a fresh tear, similar to a paper cut. If it's chronic, the tear may be deeper, and there may be internal or external fleshy growths. If the fissure lasts more than eight weeks, it's considered chronic. The location of the fissure can provide clues about its cause, with a fissure on the side of the anal opening possibly indicating an underlying disorder like Crohn's disease. Your provider may recommend further testing to identify any underlying condition.
Management and Treatment
Complications
Potential complications of an anal fissure may include:
- Failure to heal: An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
- Recurrence: Once you've experienced an anal fissure, you are prone to having another one.
- Tear extending to surrounding muscles: An anal fissure may extend into the ring of muscle that holds your anus closed. This muscle is called the internal anal sphincter. If this happens, it makes it more difficult for your anal fissure to heal. An unhealed fissure may trigger a cycle of discomfort that may require medicines or surgery to reduce the pain and to repair or remove the fissure. Remember, it's essential to see a healthcare provider if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.
Prevention
You can take measures to prevent anal fissures by:
- Avoiding constipation: Eat high-fiber foods, drink fluids, and exercise regularly to prevent straining during bowel movements.
- Managing diarrhea: Stay hydrated and use over-the-counter medications to manage diarrhea.
- Proper bathroom hygiene: Keep the anal area clean by gently washing with warm water and patting dry with toilet paper.
- Avoiding anal intercourse or using protection: This can help prevent tearing and reduce the risk of anal fissures. By following these precautions, you can lower your risk of developing anal fissures.
Home Remedies
Home remedies that may help relieve the discomfort and promote healing of an anal fissure include:
- Warm Baths: Soak in a warm-water bath for 10-15 minutes several times a day to help relax the anal sphincter muscle and promote healing.
- High-Fiber Diet: Incorporate high-fiber foods such as fruits, vegetables, and whole grains into your diet to help prevent constipation and alleviate symptoms.
- Over-the-Counter Remedies: Some over-the-counter creams and ointments, like lidocaine or nitroglycerin, can help relieve pain and promote healing. Consult with a healthcare provider before use.
- Topical Stool Softeners: Using stool softeners like docusate sodium may help make bowel movements easier and less painful.
- Witch Hazel: Applying a compress of witch hazel, which has anti-inflammatory properties, to the affected area may help reduce pain and inflammation.
- Avoid Straining: Try to avoid straining during bowel movements, as this can worsen the fissure. It is important to note that home remedies may not always be sufficient, and medical intervention may be necessary for more severe or chronic cases. Consult with a healthcare provider for personalized advice and treatment recommendations.
Treatment
Anal fissures can be treated with appropriate home treatment and medical interventions. Here are some ways to treat anal fissures:
- Home remedies: Increase your intake of fiber and fluids, and soak in warm water for 10 to 20 minutes several times a day, especially after bowel movements. This can help keep stool soft, relax the sphincter, and promote healing.
- Nonsurgical treatments: Your healthcare provider may recommend externally applied nitroglycerin, topical anesthetic creams such as lidocaine, or nonsurgical procedures like onabotulinumtoxinA (Botox) injection or blood pressure medicines like nifedipine or diltiazem. These treatments can help relieve pain and promote healing.
- Surgery: If your anal fissure is chronic or severe, your healthcare provider may recommend surgery. The most common surgical procedure for anal fissures is lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to promote healing and reduce spasm and pain. It's essential to consult with your healthcare provider to determine the most appropriate course of treatment based on your individual symptoms, age, and medical history.
Preparing for medical consultation
To prepare for an appointment for an anal fissure, you should:
- Make a list of your symptoms, including any that seem unrelated to the reason for your appointment.
- Gather information about your medical history, including any recent life changes and family medical history.
- List all medications, vitamins, or supplements you are currently taking, including doses.
- Bring a family member or friend along for support and to help remember information.
- Prepare a list of questions to ask your healthcare provider during the appointment. Some questions to consider include:
- What is likely causing my symptoms?
- Are there any other possible causes for my symptoms?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- Will treatment for the anal fissure complicate my care for other health conditions?
- Are there any restrictions I need to follow?
- Should I see a specialist?
- Are there any brochures or printed materials I can have? What websites do you recommend? Remember to communicate openly with your healthcare provider about your symptoms and concerns to ensure the best possible care.