Anal Fissure: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

An anal fissure is a small tear in the thin layer of moist tissue lining the anus. The term "anus" refers to the muscular opening at the end of the digestive tract where waste products exit the body. 

Common reasons for an anal fissure include constipation, straining, or passing large or hard stools during a bowel movement. The anal sphincter is a second muscular ring at the end of your anus that can spasm.

Anal fissures can affect people of any age, although early newborns are more likely to have them. Anal fissures may generally be healed with simple home treatments, such as increasing your fiber diet or having a warm-water bath. Anal fissure patients may require treatment or, in extreme circumstances, surgery.

Causes Of Anal Fissure

Anal fissures are commonly brought on by:

• Eliminating large or firm stools.
• Constipation 
• Difficulty passing gas.
• Prolonged diarrhea.
• Giving birth.

Less common reasons for anal fissures include:

• Another inflammatory bowel disease, like Crohn's.
• Anal carcinoma
• Aids
• Tuberculosis
• Syphilis

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Symptoms Of Anal Fissure

Symptoms of anal fissures might include the following:

• Pain during gastric emptying.
• Discomfort that might persist for a few hours after having a bowel movement.
• Vibrant red blood on the toilet paper or stool following a bowel movement.
• A small bump or skin tag at the anal opening.

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Risk Factors Of Anal Fissure

The following are some factors that may increase your risk of developing an anal fissure:

• Constipation. When straining happens during bowel motions and when passing hard stools, there is an increased risk of tearing.
• Delivery. Anal fissures are more common in women after delivery.
• Crohn's disease. This inflammatory bowel disease causes persistent inflammation of the intestines. 
• Age. Anal fissures are more common in young children and middle-aged people, while they can occur in anybody at any age.

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Diagnosis Of Anal Fissure

Apart from examining your past medical records, your physician will likely perform a physical examination that included a thorough assessment of your anal region. The tear is usually visible. To find an anal fissure, this inspection is usually enough.

An acute, more recent anal fissure resembles a freshly torn piece of paper. A chronic, or persistent, anal fissure is likely to have a deeper tear. Moreover, it could develop external or internal fleshy growths. A fissure is considered chronic if it lasts for longer than eight weeks.

The cause of the fissure can be determined from its position. If the fissure develops on the side of the anal entry rather than the front or back, Crohn's disease or another condition is more likely to be the cause. Your provider may recommend additional testing to ascertain whether you have an underlying issue. Tests could include:

• Anoscopy. To help your doctor see the rectum and anus, a tube device called an anoscope is inserted into the anus.
• A flexible sigmoidoscopy. Your healthcare provider inserts a tiny video-equipped, thin, flexible tube into the base of your colon. If you are under 45 and do not have any risk factors for colon cancer or digestive disorders, you may be able to get this test.
• Colonoscopy. During this treatment, a flexible tube is introduced into your rectum to inspect your whole colon. You may need a colonoscopy if you:
  • Are over 45 years old.
  • Possess risk factors for colon cancer.
  • Exhibit signals that indicate further ailments.
  • Possess other symptoms, such as a stomachache or diarrhea.

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Treatment Of Anal Fissure

If the proper treatment is provided, anal fissures may often heal at home in a few short weeks. To keep your stools soft, make sure you're receiving plenty of water and fiber. Soak in warm water for ten to twenty minutes many times during the day, especially after having a bowel movement. This could promote healing and sphincter relaxation. You will most likely need more care if your symptoms don't go away.

Non-invasive Techniques

What your physician may recommend is:

• External use of nitroglycerin. By increasing blood flow to the fracture, this could speed up healing. Additionally, it could help the anal sphincter relax. When more conservative methods prove futile, nitroglycerin is usually the preferred line of action. A headache has the potential to be extremely severe, is one possible side effect.
• Topical anesthetic creams such as lidocaine may help with pain alleviation.
• An injection of onabotulinumtoxinA, often known as Botox, paralyzes the anal sphincter muscle and lessens spasms.
• Blood pressure medication that helps to relax the anal sphincter, such as nifedipine or diltiazem. These drugs can be eaten, even though they're usually used topically. If ingested, they could, nonetheless, have greater detrimental effects. These drugs could be used if nitroglycerin is not working or has serious side effects. 

Surgery

If your symptoms are severe or your chronic anal fissure is not improving with earlier treatments, your doctor may recommend surgery. Usually, physicians perform the procedure known as lateral internal sphincterotomy (LIS). During LIS, a little portion of the anal sphincter muscle is cut. This technique may speed healing while reducing pain and spasms.

Studies show that when it comes to treating recurrent fissures, surgery works significantly better than any other kind of medical intervention. On the other side, one small risk of surgery is incontinence.

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Prevention Of Anal Fissure

An anal fissure may be prevented by taking precautions to prevent diarrhea or constipation. For a more comfortable gas passage during bowel movements, eat high-fiber foods, drink plenty of water, and exercise regularly.

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Complications Of Anal Fissure

Complications from anal fissures might include:

• Being incapable of healing. After eight weeks, if the anal fissure does not heal, it is considered chronic and may need further treatment.
• Reoccurrence. After anal fissure, you are more prone to develop another one. A tear deep into the surrounding muscles. You might separate your anal fissure from the ring of muscle that closes your anus. This muscle is called the internal sphincter. If anything like this happens, it gets harder for your anal fissure to heal. To break the agonizing cycle and repair or remove the fissure, unhealed fissures may require surgery or medicines.

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