Anal fissures are small tears in the membranes of the anus. They usually heal very quickly with home care, although some cases may require more aggressive treatment, and they are relatively common, especially in infants. People who observe the symptoms of anal fissures should make an appointment with a doctor for an evaluation in which the diagnosis can be confirmed. It is important to see a doctor to rule out other conditions with similar symptoms which may necessitate different treatment approaches.
People with anal fissures usually experience pain while defecating and burning pain can also be associated with urination. Bright spots of blood may appear on toilet paper or in the toilet, and the patient can also experience symptoms like itching, a strong smelling discharge, and general discomfort. It is sometimes possible to see the anal fissure in the mirror or to feel it. Some patients may try to avoid defecation because of the pain.
Causes of anal fissures can include diarrhea and constipation as well as straining to pass large stool. In addition, sometimes childbirth causes trauma to the anus which leads to fissures. If a fissure is allowed to persist untreated, it can be come chronic. Chronic fissures can lead to muscle tears which cause painful spasms and may also be associated with infections and other health problems.
A doctor can often diagnose an anal fissure with a quick physical exam. Treatments can include using stool softeners to make it easier to defecate, using unscented baby wipes instead of toilet paper, cleansing the area with mild soaps, soaking in warm water to ease pain and inflammation, and applying lubricating anti-inflammatory creams to address discomfort. Anal fissures are often curable without surgery, but in rare cases a minor surgery to repair the anal sphincter may be required.
People of all ages can develop anal fissures and this common medical issue is not necessarily the result of anything a patient did or did not do. It is important to receive adequate treatment to avoid complications. A general practitioner can usually provide patients with the diagnosis and treatments they need, and a referral can be provided if a situation is more complicated and needs the attention of a specialist. Patients should not be shy about speaking up when it comes to problems with urination and defecation even though these topics can sometimes feel awkward or embarrassing; doctors have seen it all and can provide treatment without comment or judgment.
People who develop anal fissures, which are tears in the skin that lines the anus known as anoderm, typically experience several common symptoms. Though fissures may be painless, most people experience some amount of pain from the condition, and it usually gets worse during a bowel movement. Another of the common fissure symptoms is itching and irritation around the anus. Often the patient will notice blood or discharge from the anus. In some cases, the fissure itself may be visible on the outside of the anus, and a lump or tag of skin may develop along the fissure.
Pain is the most common of the anal fissure symptoms, which the majority of patients have to some degree. Usually the pain of a fissure will increase significantly when the patient has a bowel movement. He or she might have the sensation that there is tearing or ripping within the anal canal, or it may sting or burn. The pain may be intense and may take anywhere from minutes to hours to subside.
For certain patients, the pain may still be present but significantly less between bowel movements, while for others it might subside completely. They may also find that the pain increases when they urinate. Some patients may develop constipation if the pain is so severe that they avoid moving their bowels.
Itching and irritation are also frequently anal fissure symptoms. The skin around the anus often becomes sensitive and sore, and can cause discomfort if it is touched. It may also develop an ongoing itch, a condition known as pruritus ani.
In many cases, one of the anal fissure symptoms a patient will have is bleeding. Though the amount of blood is typically minimal, it is often bright red and very noticeable on toilet paper or in the stool. Patients who have any anal bleeding should notify their doctor right away. In addition to blood, pus may seep from the tear, so some patients may also notice a foul-smelling discharge from the anus.
While some anal fissures are completely internal and may not be readily visible, it is often possible to see the tear crack in the skin around the outside of the anus. Patients may be able to see or feel lumps around the fissure. Sometimes a small tag of skin, known as a sentinal pile, can form near the end of the fissure as well.
Anal fissures are caused by trauma to the anus and anal canal. The cause of the trauma usually is a bowel movement, and many patients can remember the exact bowel movement during which their pain began. The fissure may be caused by a hard stool or repeated episodes of diarrhea. Occasionally, the insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland) can result in sufficient trauma to produce a fissure. During childbirth, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm.
Other causes of fissures are anal cancer, Crohn's disease, leukemia as well as many infectious diseases including tuberculosis, viral infections (cytomegalovirus or herpes), syphilis, gonorrhea, chlamydia , chancroid (Hemophilus ducreyi), and human immunodeficiency virus (HIV). Among patients with Crohn's disease, 4% will have an anal fissure as the first manifestation of their Crohn's disease, and half of all patients with Crohn's disease eventually will develop an anal ulceration that may look like a fissure.
It is possible for some anal fissures to heal on their own. Many fissure treatments — including Botox, creams and sitz baths — are available for tears that do not heal naturally. When other anal fissure treatments are unsuccessful, surgery may be performed to heal the tear.
Treatments can include using stool softeners to make it easier to defecate, using unscented baby wipes instead of toilet paper, cleansing the area with mild soaps, soaking in warm water to ease pain and inflammation, and applying lubricating anti-inflammatory creams to address discomfort.
A doctor may start by recommending at-home anal fissure treatments for most patients. Taking a nightly sitz bath can help to heal an anal fissure. To do this, patients should fill a bathtub with warm water up to their hips and soak for about 20 minutes. Soaking in warm water helps to promote healing by relaxing the anal muscles, which may spasm as a result of the fissure and prevent sufficient blood flow to allow healing. Relaxing the muscles allows blood flow to improve, encouraging healing.
Prescription creams containing nitroglycerin also can help an anal fissure to health faster. Patients should wear latex gloves while applying the cream and follow their doctor's instructions regarding how much cream to apply each day. Some medical professionals are using Botox injections as an anal fissure remedy. Botox can be injected into the internal anal sphincter, allowing the muscle spasms to calm down and the area to heal.
When other anal fissure treatments do not help a person to find relief, a doctor may want to perform outpatient surgery. The surgery involves the doctor making a small cut in the internal anal sphincter to relieve pressure and inflammation. Having this procedure performed is not an instant anal fissure fix. The patient will still need to take extra care with the anal area while the fissure and the incision heal.
People can avoid anal fissures by always eating a high-fiber diet. If a person is prone to constipation, he or she should speak to a doctor about taking laxatives or stool softeners to avoid getting an anal fissure. Drinking an adequate amount of water each day also can help to promote healthy bowel movements. Straining during a bowel movement is not normal. A person who constantly experiences straining every time he or she has a bowel movement should make a doctor's appointment as a preventive measure.
Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences.
Add fiber to your diet. Getting enough fiber in your diet — about 25 to 30 grams a day — improves fissure healing and helps keep stools soft. You can increase your fiber intake by eating more fruits, vegetables, nuts and whole grains. Bulk-forming laxatives, such as psyllium (Metamucil, others), soften stools and allow them to pass more easily. Adding fiber through either diet or supplementation may cause gas and bloating, so increase your fiber intake gradually.
Drink adequate fluids. Fluids also help prevent constipation, so it's important to get enough. If you're rarely thirsty and your urine looks colorless or only very light yellow, you're probably drinking enough.
Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure.
Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.