Anal fissure

anal fissures disorders

Last Updated December 20th, 2021

What is an anal fissure?

Passing hard stools can result in a tear on the skin. This slight crack or cut in the skin that lines the anus is medically termed as an anal fissure. In some cases, these cuts can go deep down to the muscle, exposing them.

Patients feel the presence of these fissures due to severe pain and bleeding, either while passing stools or after it. Although the sight of blood during a bowel movement and pain can be alarming, anal fissures by themselves are not serious.  

Constipation is often a primary cause for the formation of anal fissures. Anyone can suffer anal fissures, although it occurs in infants and children largely due to constipation. Most of the time, anal fissures do not need any medical treatment and they heal on their own within a month.  In case fissures do not heal beyond eight weeks, the condition is chronic and needs medical treatment. Doctors initially prescribe medicines to soften the stools along with pain relievers. They also study the medical history of the patient and investigate the presence of medical disorders that can increase the risk of anal fissures. If the condition does not improve with any of the remedies, doctors may recommend surgery.

Many people get confused between anal fissures, fistula, and hemorrhoids. Read in detail about them to know the exact causes, symptoms, and treatment.

Why do anal fissures occur?

Constipation commonly causes anal fissures. If the bowel movement is not easy, the hard stool causes an abnormal stretching of the anal mucosa. An initial tear gets worse with every bowel movement.

anorectal fissure

Fissures in the anal region can also occur due to frequent diarrhoea, causing the skin around the anus to rupture. Not all anal fissures signify low-fibre diets and constipation. Poorly healing fissures or those located in a position other than the posterior and midline portion of the anus may indicate an underlying condition.

If the tear becomes deep, the muscle beneath, called the anal sphincter muscle, can go into a spasm causing severe pain. The spasm usually makes the wound difficult to heal as it causes further tearing of the mucosa, each time there is a bowel movement. When this happens repeatedly, it can lead to chronic anal fissures.

Who are at increased risk of developing anal fissures?

According to the Journal of Clinical and Diagnostic Research (JCDR), 18% of people with anorectal complaints in India can develop anal fissures.

Anal fissures can also develop due to the increased strain caused during childbirth. This makes expectant women prone to the condition.

If there is a reduced flow of blood to the area around the anus, it can give rise to fissures.

Further, patients suffering some form of inflammatory bowel disease, such as Crohn’s are at an increased risk of developing anal fissures.

If anal sphincter muscles are exceptionally tight, it can also cause fissures in the region.

Infants are prone to anal fissures. Senior adults experience reduced blood flow to the anorectal area, which can lead to anal fissures.

Although extremely uncommon, anal fissures can develop due to the presence of the following medical conditions:

  • Herpes
  • Tuberculosis
  • HIV
  • Syphilis
  • Anal cancer

What signs help spot the presence of  anal fissures?

Some of the well-known symptoms of anal fissures are as follows:

  • Itchy feeling in the anus
  • Burning around the anorectal area
  • Cut or  tear in the lining of the skin in the anorectal region
  • Visible blood on the stools or on the toilet paper while wiping after passing motion
  • Small skin lump near the cut
  • Severe pain in the anus especially while passing motion
  • Burning or itching in the anal area

Are anal fissures easy to diagnose?

A general practitioner can diagnose anal fissures. The doctor usually begins by checking the type of symptoms. One of the symptoms your doctor will want to know is the presence of any pain in the area. More importantly, the doctor will ask questions regarding toilet habits.

Following this, the doctor will perform a rectal examination. The fissures are usually visible when the buttocks are parted. The doctor will also conduct a digital rectal examination to ascertain the diagnosis. To view the tear, doctors insert an anoscope, which is a thin medical tube, into the rectum to be able to see the tear. The tube allows doctors to inspect the anal canal.

In case the patient is having pain in the rectum, this examination using the anoscope may also diagnose other reasons for the pain. The presence of hemorrhoids also causes rectal pain. If doctors feel the need for better evaluation, they may ask for an endoscopy to be performed.

What is the usual form of treatment for anal fissures?

Fortunately, the majority of anal fissures do not need elaborate treatment. Doctors usually prescribe medication to help reduce pain and discomfort, as well as fasten the healing of anal fissures.

Hemorrhoids and anal fissures

Generally, patients with anal fissures heal on their own within 6 weeks. These types of fissures are medically termed acute anal fissures. Fissures that do not heal in 6 weeks and last much longer are called chronic anal fissures.

Doctors prescribe medicines as the first line of treatment. Doctors only recommend surgery, if self-help measures have not been useful.

Surgery helps effectively treat anal fissures. It carries a very slight risk of complication, though in rare cases, patients suffer bowel incontinence for a short time. In extremely rare cases, this condition is permanent.

Patients need to adopt certain self-care measures. Some of the medicines that doctors prescribe can be a pain reliever gel to reduce the pain and discomfort or laxatives to soften the faecal matter to allow its easy passage.

Anal fissures can recur especially if constipation is untreated. When fissures do not respond to traditional treatments, doctors also take the measurement of the anal sphincter to decide the next step of treatment.

What are some of the simple measures from doctors to relieve symptoms of anal fissure?

Some of the discomfort from anal fissures can be relieved with remedies at home. Here are some easy to follow techniques that will protect against the formation of anal fissures as well as help heal the existing ones.

  • Ensure intake of fluids. It is very important to stay hydrated.
  • Include at least 30g of fibre every day.  Make sure to eat adequate vegetables, fruits and wholemeal products.
  • Do not suppress the urge to pass motion. Postponing or suppressing the urge can cause constipation.
  • Regular physical exercise at least 4 times a week is necessary to relieve this condition and help easy passage of stools.
  • Take simple painkillers to relieve pain. Doctors may suggest application of nitro-glycerine ointment, which will help increase blood circulation in the region. Use of a hydrocortisone cream, such as Cortisone 10, will also assist in reducing inflammation. Ointments will cause sphincter muscles to relax and cause the anal fissures to heal faster.
  • Apply topical pain relievers, such as lidocaine, to the anus to ease discomfort. For those with nagging pain in the anal region, soaking the bottom in a tub of warm water (Sitz bath) especially after a bowel movement helps a great deal.  Sitz bath causes more blood to flow in the area, relaxing the muscles in the anal region, and reducing discomfort.
  • Take stool softeners available over the counter to make bowel movements easy.
  • Incase the symptoms do not reduce in 2 weeks, consult the Doctor.  Your physician is in a better position to evaluate your symptoms and suggest other alternative treatment.

What is a sitz bath ?

Sitz bath essentially means sitting inside a tub of warm water for about ten minutes, filled to a few inches, in such a way that the water is in contact with the anal region. Sitz bath about 3 times a day after a bowel movement aids relief. The plastic tub to be used for this purpose is available at most drugstores. Doctors may recommend the use of certain additives in the water for sitz bath, such as Epsom salt.

How do I increase the intake of fibre in the diet?

We need to include at least 25 to 30 grams of fibre in our diet each day. This is an achievable objective, although many adults fall short of it. If the diet contains the required amount of fibre, it can help prevent constipation as well as diarrhoea. The following are examples of food items that are high in fibre. Consuming adequate quantities of fibrous food can prevent the formation of anal fissures.

Here is a list of some of the popular food items that contain adequate fibre:

  • Soybeans
  • Lentils
  • Bran cereal
  • Pumpkin seeds
  • chickpeas
  • Wheat bran flakes
  • Split peas
  • Beans
  • Shredded wheat cereal
  • Cowpeas
  • Wheat bran flakes
  • Avocado

What are stool softeners?

Stool softeners are agents that work by drawing more water into the digestive tract. This helps in softening the stools and prevents constipation. They are not laxatives. Stool softeners are usually safe for use and are available as tablets, liquids, capsules and other types of formulations.

To compensate for stool softeners, it is important to make lifestyle changes. It is not a good idea to consume for a prolonged period. Before buying a stool softener, take the recommendation of your physician about the brand and type that may be most helpful in relieving constipation.

Few easy tips to increase the intake of water

How much water is adequate in a day is dependent on one’s own needs. Generally, consuming about 3.7 litres of water for men and 2.7 litres for women is a standard. Post-exercise, it is important to consume water. Pregnant women also need to up their water intake. This is the case with breastfeeding mothers as well.

Reduced water intake is one of the overriding reasons for constipation. Constipation can lead to a host of health issues, the development of anal fissures being one of them. Drinking adequate water is the best way for easy bowel movements. Along with water intake, it is a good idea to consume foods that have higher water content.

List of food that is high on water content:

  1. Cucumber
  2. Spinach
  3. Watermelon
  4. Sweet peppers
  5. Cantaloupe
  6. Tomato
  7. Lettuce
  8. Broccoli
  9. Zucchini
  10. Strawberries
  11. Celery
  12. Cabbage

What are some of the alternative treatments to relieve anal fissures?  

Botox injections are another form of treatment. During this treatment, Botox is injected into the anal sphincter. This stops the muscles in the anal area from going into spasms by temporarily paralysing the muscle. This promotes the healing of anal fissures and also protects against the formation of new ones.

In the event that the anal fissure does not show any positive outcome with other treatments, doctors may perform another procedure an anal sphincterotomy. This is a minor surgery, where a medical expert makes a small cut in the anal sphincter to relax the muscle. This causes the muscles to heal faster.

Fissures that do not heal may mean the need for further investigation. Check with your doctor if you need further tests.

Is it possible to prevent anal fissures?

It is difficult to prevent the development of anal fissures. However, there are certain measures patients can take to lower the risk of developing anal fissures.

  • Regular exercise to prevent constipation
  • Ensure timely treatment for diarrhoea
  • Keep anal region clean  and dry
  • Drink adequate fluids
  • Include sufficient vegetable, fibre, and fruits in the diet
  • In the case of babies, diapers must be changed often

How does regular physical activity prevent anal fissures?

Regular and moderate physical activity, which means at least 30 minutes or more of walking or any other form of exercise, enhances blood circulation to all body parts. This improves bowel movements and can prevent the formation of anal fissures. 

What are the steps to adopt good anal hygiene?

Good anal hygiene plays an important part in reducing the risk of developing anal fissures.

  • Wash the anal region clean everyday with water. Additionally, use a soap-free cleanser or cream instead of soap to clean the anal area. Natural oils help protect the anus and prevent dryness and itching in the area. Harsh soaps can deplete these natural oils.
  • Also, do not use too much force while wiping with toilet paper. This can cause the skin to chaf leading to inflammation or infection.  
  • Never use chemicals or cleansing wipes in the anal region
  • Avoid sitting on the toilet for a long time

Best treatment options for anal fissures

Surgery is the best treatment option for chronic anal fissures in.  Anal fissure surgery or sphincterotomy is not even as painful as the fissure itself.

Our treatment is complete with everything under one roof. As a first step, we completely understand your medical history as well as your medical condition. For instance, our services are as follows:

  • Choose the right specialist and schedule your appointment for consultation
  • Provide  precise information about treatment options
  • Help take the decision to undergo surgery or not
  • Taking care of your medical insurance if any
  • Providing post-treatment care where required
  • Assisting with nutrition and diet consultation
  • Offering tips for preventing recurrence of fissures

Lateral internal sphincterotomy

The best surgical option for the treatment of chronic anal fissures is a lateral internal sphincterotomy. According to statistics, more than 90% of patients undergoing this surgery completely heal. Sphincterotomy is usually performed under local anaesthesia. The healing time after sphincterotomy is 8 weeks and patients are completely normal within this timeframe. They can also resume their normal activities within 2 to 3 weeks after the surgery.

Some of the surgeons that have a diode laser at their centre also perform laser surgery for anal fissures. The benefit of laser surgery is it can be performed in an outpatient setting. Laser surgery does not require much preparation with no necessity for the hospital admission. Further, laser surgery does not involve wounds and cuts, therefore there is no loss of blood too. The patient can return home in a few hours after the surgery.

Your specialist is in a good position to decide what form of surgery will benefit you the best. This is because laser surgery may not benefit all patients. Take the advice of your specialist and do not delay treatment.

 

Facts

Fissures and hemorrhoids are not the same. Although the cause for both fissures and hemorrhoids can be a hard stool, the latter is due to the swelling of blood vessels outside or inside the anus.

Facts

Both men and women can get anal fissures at any age. Nearly 1 out of 10 people suffer from anal fissures at some time in their life. Thus, anal fissures are relatively common.

Facts

The risk of anal fissures is high among children and young adults between the age group of 10 and 30 years.

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Dos and Don'ts

Dos

Adopt a healthy diet with adequate fibre
Consume plenty of probiotic-rich food
Ensure regular schedule for bowel movements
Reduce intake of alcohol
Limit consumption of caffeine.

Don'ts

Over strain while having a bowel movement
Allow the anal region to remain wet and moist
Eat heavy meals
Regularly consume laxatives
Control the urge to poo

 

 

 

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Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
CLA: A breakthrough weight loss supplement with minimal side effects Tried every weight loss supplement in the market with no substantial gain? Why not try CLA supplements, derived…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
CT-scan-machine
CT – Computed Tomography Scan CT scan or computed tomography scan is an diagnostic imaging technique where cross-sectional images of body are obtained…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
smelling-salts-benefits
The actual science behind smelling salts and how it helps in injury recovery Most smelling salts are a mixture of ammonium carbonate and some perfumes which are sniffed by an individual…
low fodmap plan
Troubled with IBS? Here’s a complete roadmap to the low FODMAP diet Leaky & inflammatory gut troubling you? No medicine bringing you relief from the pain? Why not try the…
Vitamin K2: 8 reasons why you need this bone-building & cancer-fighting nutrient Vitamin K2 is claimed to be essential for your bone health, for reducing the risk of cancer, and…
colposcopy
Colposcopy Colposcopy is a simple, quick and non- invasive diagnostic tool to look closely inside the vulva, vagina, and…
thyroid_scan
Thyroid Scan Thyroid scan is a diagnostic procedure that aims to view the thyroid gland and detect any growths or…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
Oxalates: How healthy greens can sometimes be bad news for your kidneys Oxalates are compounds present in a majority of healthy foods. However, at times an overconsumption of these could…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
chloride test
Chloride Test A chloride test of the blood checks the level of chloride in body, an important factor governing the…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
dance health benefits
5 unbelievable effects of dance on your overall health! You enjoy dancing, but did you know what else it does to your body? Dancing is not only…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
dandelion health benefits
Dandelion: Little parachutes of health and wellness for your whole body Dandelions are not just bright looking blossoms that cheer your mind. These are powerpacked with essential nutrients that…
Jackfruit: Slice your way into higher immunity, better digestion, & more… Native to the South East Asia, the jackfruit is a fruit brimming with thousands of health benefits. Discover…
Juice Plus: Can you really replace actual fruits with pills?  Juice Plus supplements intend to fill nutritional gaps present in our daily diet. But how successful have they…
dandelion weight loss
Caralluma Fimbriata: How to eat this cactus to lose weight Caralluma fimbriata is a miracle cactus that can be safely consumed by most for losing weight and boosting…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
What to eat, what not to eat in the South Beach Diet? The South Beach Diet is one among the most popular weight loss programs that have been the talk…
Vagus nerve: 7 health benefits of stimulating the “gut-brain” connection As a matter of fact, there are two vagus nerves namely the left and the right but is…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
fructosamine test
Fructosamine Test A fructosamine test measures blood sugar glucose content. Fructosamine level can indicate blood sugar level in past 2-3…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
Jicama: A fiber-rich tuber for your weight loss goals Pronouced as HEE-kah-ma, Jicama is the "new kid on the block" that has taken the world by the…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
Piaget stages: Do they accurately describe the way the human brain develops?  A common assumption was that children are less competent thinkers as compared to adults, but this was refuted…
Ear pain model
Easy and safe tips for ear wax removal you can do at home Cerumen impaction generally occurs when an external object like cotton swabs are used to remove the ear wax.…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
Chest X-Ray A chest x-ray is a diagnostic test that uses x-rays to visualize the structures inside your chest. It…
valproic acid test
Valproic Acid Test Valproic acid test is performed to generally check for psychiatric and even neurological conditions such as bipolar disease…
PROGESTERONE_test
Progesterone test The progesterone test is a blood test used to determine the level of hormone progesterone in the blood…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
carrageenan seaweed
Carrageenan: How a simple seaweed extract could better your gut health & immunity Eat more ice cream to prevent cold and flu? –With carrageenan you get one simple seaweed extract that…
aspartame or sugar
Aspartame – Hidden truths about this storm in a teacup Aspartame, the artificial sweetener, has gone under the scanner on several occasions for allegedly doing more harm than…
improve digestion weight loss
Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
Agave nectar: The bitter truth about this sweetener revealed Agave nectar is considered to be sweeter than the normal table sugar and even contains higher amounts of…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
Plexus Slim: Is this pink slimming drink the ultimate one-stop fat burner? How effective is Plexus Slim in helping people lose weight? What are its ingredients? Can it be safely…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
Top reasons why you need to pay attention to your vitamin B6 intake Vitamin B6- An essential water-soluble vitamin. Its deficiency leads to physical changes such as sores & glossy tongue…
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
antihepatitis core antigent
Anti-Hepatitis B Core Antigen (AHBc) Total Anti-hepatitis B core antigen (AHBC ) is a blood examination and the only serological marker of infectious blood…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
lose weight fast
12 easy and instant steps to successful weight loss Do you want to lose weight without losing your mind? Does weight loss always mean saying goodbye to…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…
50 common health conditions
What are the top 50 deadly and widespread diseases? A complete list of the top 50 most common and deadly diseases that plague humanity. Which disease is…