Anal fissure

Medicine and Health

Anal fissure

An anal fissure is a narrow tear that extends from the muscles that control the anus (anal sphincter) up into the anal canal. These tears usually develop when anal tissue is damaged during a hard bowel movement or when higher-than-normal tension develops in the anal sphincters.

Symptoms of an anal fissure include a sharp, stinging, or burning pain during a bowel movement. The pain, which can be severe, may last a few hours. You may also notice spots of bright red blood on toilet tissue. This blood is separate from the stool.

Minor anal fissures can often be helped to heal by drinking more fluids, eating a high-fiber diet, allowing enough time for a bowel movement, and using stool softeners.

Symptoms

The symptoms of an anal fissure may include:

• A sharp, stinging, or burning pain during bowel movements. Pain from a fissure may be quite severe. It can be brief or last for several hours after a bowel movement.
• Itching.
• Bleeding. You may see a small spot of bright red blood on toilet tissue or a few drops in the toilet bowl. The blood from a fissure is separate from the stool. (Very dark, tarry stools or dark red blood mixed with stool may be a sign of a more serious problem.) Tell your doctor if you have any bleeding with a bowel movement.

Sometimes an anal fissure may be a painless wound that won't heal. It may bleed from time to time but cause no other symptoms.

Causes

Anal fissures are caused by injury or trauma to the anal canal. Injury can happen when:

• You pass a large stool.
• You are constipated and try to pass a hard stool.
• You have repeated diarrhea.
• You give birth. (Childbirth can cause trauma to the anal canal.)

Fissures can also be caused by a rectal exam, anal intercourse, or a foreign object. In some cases, a fissure may be caused by a health problem, such as Crohn's disease.

Many experts believe that extra tension in the two muscular rings (sphincters) controlling the anus may be a cause of fissures.

Diagnosis

How is an Anal fissure diagnosed?

A doctor can diagnose an anal fissure based on your symptoms and a physical exam. The exam may include:

• Looking at the fissure by gently separating the buttocks.
• A digital rectal exam. The doctor inserts a gloved finger into the anal canal.
• Anoscopy. This involves using a short, lighted scope to look into the anal canal.

The doctor may wait until the fissure has started to heal before doing a rectal exam or Anoscopy. If an exam needs to be done right away, medicine can be used to numb the area.

During an exam, a doctor can also find out whether another condition may be causing the fissure. Having several fissures or having one or more in an area of the anus where fissures usually don't occur can be a sign of a more serious problem, such as inflammatory bowel disease or a weakened immune system.

Treatment :-

Most anal fissures heal in a few days or weeks with home treatment. But if a fissure lasts more than 8 to 12 weeks, you may need prescription medicines. These may include cream or gel vasodilator medicines or botulinum toxin (Botox) injections.

In rare cases, surgery may be needed. The most common surgery is called a lateral internal sphincterotomy. In this procedure, a doctor cuts into part of the internal sphincter to relax the spasm that is causing the fissure.