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.

Related Conditions

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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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Sciatica pain relief: Get rid of the pain with these easy daily tips Researchers have claimed that not only heat but icing the area too helps relieve sciatica pain. Find out…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
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.…
EEG
Electroencephalogram – EEG EEG or electroencephalogram is a diagnostic tool used to access the functioning of neurons and brain activity to…
thyroid_scan
Thyroid Scan Thyroid scan is a diagnostic procedure that aims to view the thyroid gland and detect any growths or…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
copper serum test
Copper Serum Test Copper serum test checks for abnormal levels of copper in the body. Both high and low levels of…
social media adddiction
Your health in the age of Social Media: Why is digital detox a necessity? Did you know that more than 400 million people are dangerously addicted to social media? Are you one…
stevia side effects
Stevia: A healthy sugar substitute or yet another risky additive? Stevia is a plant native to South America.  It has been used as a natural sugar substitute and…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
GM Diet: The fastest way to lose weight or yet another hoax diet? General Motors started this trend of extreme dieting for 7 straight days to ensure its employees were able…
Gingko Biloba: Therapeutic lessons from the world’s oldest tree The Ginkgo Biloba, well known as the maidenhair,is the oldest living tree and the oldest living fossil. It…
Goji berry: A traditional Chinese berry that packs the best of antioxidants Goji berry is an ancient berry that is considered to be power-packed with nutrients and antioxidants. Which means…
How accurate is the hair follicle drug test? Hair follicle drug test is one of the best ways to identify drug use in professional circles. But…
Appendix pain: Recent findings on this not-so vestigial organ The exact function of the appendix is still not clear. Some consider it as an organ that once…
sodium chloride
Halotherapy: How inhaling salt can work wonders for your body Halotherapy is quickly gaining popularity amongst those with respiratory diseases. It has shown promise in its treatment.
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
blood elements analysis
Blood Element Analysis Test A blood element analysis is a blood test performed to measure the level of toxic elements such as…
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…
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…
occupational hazards types
Occupational Hazards: How to vouch for your health at your workplace Occupational hazards affect millions worldwide. Chemical spills, faulty wires, deadly pathogen, and work-stress can happen anytime. Follow these…
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
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…
hYdroxycut pills
Hydroxycut: How safe are these so-called weight loss supplements? Hydroxycut is a blend of several different ingredients formulated to promote weight loss; powered by a key weight…
Oil of Oregano: The one-stop essential oil you’ve been looking for Are you plagued by a weak immune system? High body inflammation accompanied by pain and infections? Why not…
Exercises or diet? Find out the healthiest way to gain weight Tired of being called skinny all the time? Looking for healthy ways to beef up? Why not try…
Did you know drinking alkaline water could be the healthier choice for you? Ever wondered how safe is your drinking water in terms of pH? Recent studies have revealed that Alkaline…
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…
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…
How to scrub away stress and fatigue with an Epsom salt bath? Epsom salt is a popular home remedy for many skin ailments. Though there is a lack of scientific…
Surgery or home-remedy; what is the right way to treat a burn The treatment of a burn injury depends on its severity. You can save a life by offering the…
6 arguments in favour of glucosamine and where can you find it Studies have shown that glucosamine works by preventing the breakdown of cartilage of the joints. This is usually…
Bronchoscopy procedure
Bronchoscopy Bronchoscopy is a procedure where in a scope is inserted into the lung pathway to observe any growth…
LFT-test
Liver Function Test – LFT LFT or Liver Function Test is a blood test used to determine the levels of hepatic enzymes which…
PROLACTIN-(PRL)
Prolactin Test (PRL) Prolactin or PRL is a lactogenic hormone produced to induce milk production in lactating mothers. PRL test measures…
EMA antibodies
Endomysial Antibodies (EMA) Test EMA test is an investigative blood examination to locate the presence of certain antibodies, called Endomysial antibodies or…
dhea adrenal
Androstenedione Test Androstenedione is produced by the adrenal gland, the test of the levels of Androstenedione helps in the evaluation…
calories healthy
Calories: How to keep a check on these for faster weight loss Did you know you can burn calories while sleeping? Calorie-burning is what causes weight loss. How much should…
black seed oil benefits
Black Seed Oil: What secret benefits could it bestow on your health? Black seeds or nigella seeds are tiny packets of health brimming with amazing benefits. Find out why should…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
How can berberine supplements help you live longer and healthier? Berberine is a turmeric look-alike herbal extract that is credited with numerous health benefits ranging from diabetes cure…
Find all the instant ways to get rid of blackheads Blackheads - Not only are they aesthetically unappealing but if left untreated these can cause bacterial overgrowth on…
waterchestnut
Water Chestnuts: The tastiest ways to include this healthy tuber in your diet Water chestnut is not a nut after all. It is a tuber (much like the potatoes) growing close…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus 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…
PROSTATE-SPECIFIC-ANTIGEN
Prostate-Specific Antigen (PSA) Test Prostate specific antigen test is a blood test used to determine the presence of prostate cancer or any…
bilirubin-test-result
Bilirubin Test Bilirubin is a substance produced in the body as a result of red blood cell breakdown. A bilirubin…
biopsy procedure
Biopsy Biopsy is a procedure of studying a live tissue sample collected from a specific organ for diagnosing a…
beta 2 glycoprotein 1 IgG
Beta 2 Glycoprotein 1 IgG Beta 2 glycoprotein 1 antibody test involves detecting and measuring the presence of the IgG class of beta…
lp-pla2
LP-PLA2 Test The LP-PLA2 test is a test which is carried out to assess the levels of Lipoprotein-Associated Phospholipase A2…
AUTOIMMUNE HEPATITIS liver
Hepatitis Profile A hepatitis profile or a hepatitis panel is a blood test that checks for markers of hepatitis infection…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
Serotonin happiness
Serotonin: What you didn’t know about this “feel-good” chemical Serotonin : Did you know that this "feel-good" hormone could well impact your sleep cycle, sex drive, appetite,…
Bulletproof coffee recipe
Bulletproof Coffee – Breakfast of champions or yet another health fad? Can this special ketogenic coffee really make your body race as fast as a bullet?
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
Pumpkin Seeds: Why pumpkins are more than just for pies! Pumpkins have been long associated with Halloween carvings and delicious pies. But did you know that pumpkin seeds…