Health Blog Details

An anal fissure, or fissure as it is commonly called, is a small tear in the moist, thin tissue that lines the anus (the muscular opening at the end of the digestive tract where stool exits the body). Anal fissures are usually very common in young infants, but they can affect people of any age. Most of the time, anal fissures get better with simple treatments like increased fiber intake or soaking in a warm-water bath. If that doesn’t work, people with anal fissures may need medicine. If even medicines don’t work, your doctor may recommend surgery. You need to visit a good gastroenterology hospital if you are experiencing any symptoms.

Fissures may become chronic if they are not healed properly. Anal fissures that last more than eight weeks are considered to be chronic. Also, anyone who has once experienced an anal fissure is prone to having another one. You can prevent anal fissures by taking measures to avoid constipation and diarrhea. You can eat high-fiber food, drink plenty of water or other fluids, and exercise regularly to keep from having to strain yourselves during bowel movements.

Causes of Fissure

Common causes of an anal fissure include constipation, straining or passing hard or large stools during bowel movements. Other causes may include long-lasting diarrhea, anal intercourse, and childbirth. Other less common causes of anal fissures include Crohn’s disease or other inflammatory bowel diseases, anal cancer, HIV, TB, and syphilis.

Fissure Symptoms

Anal fissures can cause pain and bleeding during bowel movements. The pain can last up to several hours. You may see bright red blood on the stool after bowel movements.  Additionally, the anal sphincter, a ring of muscle at the end of your anus, may spasm. There might even be a visible crack in the skin around the anus or a small lump or skin tag on the skin near the anal fissure. You need to see a doctor if you have pain during bowel movements or notice blood on your stools.

Diagnosis of Fissure

If you consult your healthcare provider with symptoms of a fissure, they will likely ask you about your medical history. Your doctor will then perform a physical examination which will include a gentle inspection of your anal region. 

Usually, the tear is visible, and this exam is enough to diagnose an anal fissure. The fissure’s location gives clues about its cause. If the fissure occurs on the side of the anal opening, other than the back or front, it is likely a symptom of another like Crohn’s disease. In such cases, your doctor may recommend further testing to see if you have an underlying condition. These tests may include an anoscopy, flexible sigmoidoscopy or colonoscopy.

Fissure treatment

If you get appropriate home treatment, anal fissures often heal within a few weeks. Home remedies include taking steps to keep your stool soft but increasing your intake of fiber and fluids. You can also soak in warm water for 10 to 20 minutes multiple times a day, especially after bowel movements. Doing this can help relax the sphincter and promote healing, thereby reducing fissure pain. But if your symptoms persist, you will likely need further treatment. 

As a part of nonsurgical treatments, your healthcare provider may recommend externally applied nitroglycerin (Rectiv) to help increase blood flow to the fissure and promote healing. But, it does have side effects like severe headaches. They may also prescribe topical anesthetic creams like lidocaine to help relieve pain. In some cases, botox injections are prescribed to paralyze the anal sphincter muscle and relax spasms. Blood pressure medicines also help relax the anal sphincter.

Fissure Surgery

If no other fissure anal treatments work, or if your symptoms are severe, your doctor may recommend surgery. The common procedure that doctors usually perform is called lateral internal sphincterotomy (LIS). This surgery involves cutting a small portion of the anal sphincter muscle. It is known to promote healing and reduce spasms and pain. Studies show that this surgery is more effective than any other medical treatment for chronic fissures. However, LIS poses a small risk of causing incontinence.

Fissure Risk Factors

Certain risk factors like constipation, childbirth, Crohn’s disease, anal intercourse, and age increase your risk of developing an anal fissure. Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation of the intestinal tract. It makes the lining of the anal canal more vulnerable to tearing.