An anal fissure is a slight tear that occurs in the moist tissue lining of the anus. It is usually a result of passing hard or large stools during a bowel movement.
Anal fissures cause great discomfort and are often accompanied by pain and bleeding while passing stools. The ring of muscle at the end of your anus, also called the anal sphincter, may experience spasms due to such fissures.
The common causes of anal fissures are discussed below.
What Causes An Anal Fissure?
Anal fissures may be caused by:
- Passing hard or large stools during a bowel movement
- Constipation that causes one to strain during a bowel movement
- Anal intercourse
- Chronic cases of diarrhea
The less common causes of anal fissures include:
- Inflammatory bowel diseases like Crohn’s disease
- Anal cancer
Some factors may put an individual at a higher risk of developing anal fissures.
The risk factors for anal fissures are:
- Childbirth – Anal fissures are quite common in women after giving birth.
- Age – While anal fissures may occur at any age, they are more common in middle-aged adults and infants.
Individuals affected by anal fissures tend to exhibit the following signs and symptoms.
Signs And Symptoms Of Anal Fissures
The signs and symptoms associated with anal fissures are:
- Pain during bowel movements, which may vary in severity
- Pain that lasts up to several hours after passing stool
- Blood spots in the stool (or toilet paper) after a bowel movement
- A noticeable crack in the skin around the anus
- Presence of a small skin tag on the skin near the anal fissure
If you experience any of these symptoms, it is best to get yourself diagnosed to rule out other possibilities.
How Are Anal Fissures Diagnosed?
To diagnose anal fissures, your doctor may ask about your medical history. This may be followed by a physical examination that includes a gentle examination of the anal region.
The fissure or tear is usually visible and can be easily diagnosed with a physical examination.
If an underlying condition is suspected, your doctor may suggest other diagnostic tests like anoscopy, flexible sigmoidoscopy, or colonoscopy.
An acute fissure looks like a fresh paper cut, whereas a chronic anal fissure is a deeper tear that may be accompanied by internal/external fleshy growths. Anal fissures are considered to be chronic if they last for more than eight weeks.
Once diagnosed, you can discuss the available treatment options with your doctor.
Over-The-Counter Treatment For Anal Fissures
An anal fissure can ease within a few weeks if you make a few changes that will help in keeping your stool soft.
Over-the-counter (OTC) treatments are also available for treating the symptoms of anal fissures. They include:
- Topical application of nitroglycerine (Rectiv) externally to enhance blood flow to the fissure and promote healing.
- Topical use of anaesthetic creams like lidocaine hydrochloride (Xylocaine).
- Botox (Botulinum toxin type A) injection to relax spasms by paralyzing the anal sphincter muscle.
- Blood pressure medications like oral diltiazem (Cardizem) or nifedipine (Procardia) to relax the anal sphincter.
Those with a chronic anal fissure that does not respond to OTC treatments may require surgery. A procedure called lateral internal sphincterotomy (LIS), which involves making a small incision to remove a portion of the anal sphincter muscle, is one of the most commonly used surgeries for chronic fissures.
While surgery is the best option to treat chronic fissures, acute fissures can be easily managed and treated with the help of some natural remedies.