Anal Fissure
A small tear in the tissue lining the anus
What is an Anal Fissure?
An anal fissure is a small tear or crack in the thin, moist tissue (mucosa) that lines the anus. Anal fissures are common and can cause significant pain and bleeding during bowel movements. They typically occur when passing large or hard stools, though they can also result from prolonged diarrhea or other trauma to the anal area.
Common Symptoms
Anal fissures can cause various symptoms that may affect bowel movements and daily comfort:
- Blood in stool - Fresh red blood on toilet paper or in the toilet bowl
- Sharp abdominal pain - Intense pain during and after bowel movements
- Pain of the anus - Severe, burning pain that can last for hours
- Rectal bleeding - Bright red blood from the rectum
- Changes in stool appearance - Blood visible on or mixed with stool
- Constipation - Difficulty passing stools, often worsening the condition
- Lower body pain - Discomfort in the pelvic and anal region
- Vaginal dryness - May occur in women due to proximity of tissues
Common Causes
Anal fissures can develop due to various factors:
- Large or hard stools: The most common cause, creating excessive stretching of the anal opening
- Chronic constipation: Straining during bowel movements increases pressure
- Prolonged diarrhea: Frequent, loose stools can irritate and damage anal tissue
- Childbirth: Trauma during vaginal delivery can cause anal fissures
- Inflammatory bowel disease: Conditions like Crohn's disease increase risk
- Anal intercourse: Can cause tears in the anal lining
- Tight anal sphincter: Increased muscle tension can predispose to fissures
Types of Anal Fissures
Acute Anal Fissure
Recent tears that are shallow and heal within 6-8 weeks with proper care. These typically have clean, sharp edges and may bleed easily.
Chronic Anal Fissure
Long-standing fissures that have been present for more than 6-8 weeks. They may have deeper tears, skin tags, or scarring at the edges.
Treatment Options
Conservative Treatment
- Dietary changes: Increase fiber intake and fluid consumption
- Stool softeners: Help prevent hard stools that can worsen fissures
- Topical anesthetics: Provide pain relief during bowel movements
- Sitz baths: Warm water baths can promote healing and provide comfort
- Nitroglycerin ointment: Helps relax the anal sphincter and improve blood flow
Medical Procedures
- Botulinum toxin injection: Relaxes the anal sphincter muscle
- Lateral internal sphincterotomy: Surgical procedure to release sphincter tension
- Advancement flap procedure: For complex or recurrent fissures
When to See a Healthcare Provider
Seek medical attention if you experience:
- Persistent pain that doesn't improve with home treatment
- Significant bleeding from the rectum
- Signs of infection (fever, increased pain, pus)
- Fissures that don't heal within 6-8 weeks
- Changes in bowel habits or stool appearance
- Severe pain that interferes with daily activities
Prevention
- Maintain regular bowel movements with adequate fiber intake
- Stay well-hydrated by drinking plenty of water
- Avoid straining during bowel movements
- Practice good anal hygiene without excessive wiping
- Treat constipation promptly to prevent hard stools
- Use proper lubrication during anal intercourse