An anal fissure is a tear or open wound in the tissue of the anus that can cause pain and/or bleeding during a bowel movement. It can develop in anyone, regardless of gender or age, but is most common in infants and small children due to constipation.
Causes
- Stool that is too large or too hard.
- Reduced blood flow to the anus.
- Chronic constipation or diarrhea.
- Vaginal childbirth.
- Inflammatory bowel disease (IBD) or Crohn's disease.
- Contraction of the sphincter.
- Various diseases such as rectal cancer, HIV (human immunodeficiency virus), and tuberculosis. Note that these are rare.
Risk Factors
- Infants and small children.
- Elderly individuals.
- Individuals with constipation.
- Women who have had vaginal childbirth.
- Patients suffering from Crohn’s disease.
- Individuals who engage in anal intercourse.
Symptoms
- Visible tear or wound present around the anus.
- Pain that can last up to several hours after bowel movements.
- Anal pain or burning, which can be severe, during bowel movements.
- Presence of blood on the stool or toilet paper after a bowel movement.
- Itching or irritation around the anus.
- Small bump or skin tag located near the anal fissure.
Diagnosis
- Patient history and symptoms, including toileting habits.
- Physical examination of the anus where the doctor may use a gloved finger to feel inside the anus or use an anoscopy.
- Laboratory tests to diagnose other problems, such as syphilis or HIV.
Treatment
Lifestyle changes for easier bowel movements
- Increase your intake of high-fiber foods and stay hydrated.
- To promote blood circulation to the anus and help the sphincter relax, sit in warm water after passing stool. Repeat this 2-3 times a day for 10-20 minutes each time.
- Regular exercise can help move your bowels and maintain regular bowel movements.
- If constipation is severe, your doctor may recommend fiber supplements, laxatives, or stool softeners.
Medication
- Topical medication can be used to relieve pain.
- Medication such as nitroglycerin or Botulinum toxin can be used to relax the sphincter.
- Antibiotics may be necessary if the wounds become inflamed or infected.
Surgery
- A procedure called lateral internal sphincterotomy can be done to release the sphincter muscles and reduce pain during bowel movements. This can also help the wound heal faster, and make bowel movements less difficult.
Prevention and Risk Reduction
- Ensure proper hygiene of the anal area by keeping it clean and dry.
- Stay hydrated and consume fiber-rich foods to promote smooth bowel movements.
- Incorporate regular exercise into your routine to encourage healthy digestion.
- Address cases of diarrhea promptly and effectively.
- For infants, regularly changing their diapers can prevent irritation and potential injury.
