An overview of anal fissures: Symptoms, causes and treatment

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Anal Fissures
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Anal Fissures

• An anal fissure is a tear in the lining of the
  anus or anal canal (the opening through which
  stool passes out of the body). The fissure can be
  painful and may bleed. 

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Causes of an anal fissure

• Anal fissures can be caused by trauma to the anus
  and anal canal. The cause of the trauma can be
  one or more of the following Chronic
  constipation
• Straining to have a bowel movement
• Prolonged diarrhoea
• Anal sex, anal stretching
• Insertion of foreign objects into the anus

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Causes of an anal fissure
Continue

• Causes other than trauma include 
• Long-standing poor bowel habits
• Overly tight or spastic anal sphincter muscles
  (muscles that control the closing of the anus)
• Scarring in the anorectal area
• Presence of an underlying medical problem such
  as Crohn's disease and ulcerative colitis
• Decreased blood flow to the anorectal area

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Symptoms

• Signs and symptoms include 
• Pain during, and even hours after a bowel
  movement
• Constipation
• Blood on the outside surface of the stool
• Blood on toilet tissue or wipes
• A visible crack or tear in the anus or anal canal
• Burning and itch that may be painful
• Discomfort when urinating, frequent urination, or
  inability to urinate
• Foul-smelling discharge

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Diagnosis of an anal fissure

• Usually your doctor can diagnose an anal fissure
  by visual inspection of the anus or by gentle
  exam with the tip of the finger. 

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Risk for the development of anal fissures

• Anal fissures can occur in anyone at any age.
  Generally, the chance of an anal fissure
  occurring decreases as age increases. However,
  people who have had fissures in the past are more
  likely to have them in the future. 

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Treatments

• The goal of treatment is to lower the pressure
  on the anal canal by making stools soft as well
  as easing pain and bleeding. Conservative
  treatments are tried first and include one or
  more of the following
• Preventing constipation through the use of stool
  softeners, increased intake of fluids while
  avoiding caffeine-containing products (which
  cause dehydration), and dietary adjustments
  (increase in intake of high fibre foods and fibre
  supplements).
• Soaking in a warm bath, 10 to 20 minutes several
  times a day, to promote the relaxation of the
  anal muscles.
• Cleansing the anorectal area more gently
• Avoiding straining or prolonged sitting on the
  toilet
• Using petroleum jelly to help lubricate the
  anorectal area

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Treatments
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• When treatments fail and anal fissures persist
  or recur other measures can be tried, including 
• Using hydrocortisone-containing suppositories,
  foams, or creams to reduce inflammation
• Applying other creams and ointments these may
  include a medicated cream
• Injecting botulinum toxin type A (Botox) into the
  anal sphincter. The injection temporarily
  paralyzes the anal sphincter muscle, relieving
  pain and promoting healing
• Surgery

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Prevent the development of an anal fissure

• For fissures in infants change diapers
  frequently and treat constipation For fissures
  in adults 
• Keep the anorectal area dry
• Wipe the area with soft materials, a moistened
  cloth, or cotton pad avoid rough and scented
  toilet paper
• Promptly treat all occurrences of constipation
  and diarrhoea
• Avoid irritating the rectum

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