Anal Fissure: What It Is, Symptoms, Causes & Treatment

An anal fissure is a tiny tear or a crack in the skin around the anal canal that can cause severe discomfort and pain, especially while passing stools. It is quite common, with many people getting it on and off in their lives due to reasons like constipation or diarrhea. 
This blog will go further into what an anal fissure is, the symptoms of an anal fissure, the different causes of anal fissures, and effective ways to treat them. We shall also discuss the prevention of this painful condition.

What is an Anal Fissure?

An anal fissure is basically a small painful tear or crack in the lining of the anus. These tears have numerous causes and are terribly painful especially while going through bowel movements. 
The tissue around the anus is very delicate, and if stretched or torn, it leads to an anal fissure. The condition itself is not serious most of the time, but the pain is excruciating to a point of being debilitating; if not treated well, it could end up with chronic fissures or other complications.

Are Anal Fissures Common?

Yes, anal fissures are fairly common. They can occur in any individual regardless of age but are especially common among infants, children, and people in their middle-thirties to about early forties. Some reports maintain that 1 out of every 10 persons will suffer an anal fissure at some point during their lifetime.
Constipation is the commonest risk factor affecting this age group. Though the fissure may affect anybody at any time, persons with risk factors such as chronic constipation or anal intercourses are more likely to develop it.

What are the Symptoms of Anal Fissure?

The symptoms of anal fissures are generally easy to recognize. The commonest symptom is a sudden onset of sharp pain during and after bowel movements. The pain would be so distasteful that it could go on for hours after a stool is passed. Other symptoms of anal fissure are: 

• Sharp pain or stinging sensation occurs in or after a bowel movement.
• Blood on toilet paper or in the stool, usually bright red.
• A tear or crack around the anus can be witnessed.
• Itching or irritation around the anus.
• A lump or skin tag adjacent to the fissure, which may develop as a result of a trauma sustained by the fissure remaining for an extended period in the area.

How Do I Know If I Have a Hemorrhoid or an Anal Fissure?

Both hemorrhoids and anal fissures can cause similar symptoms of pain, bleeding, and slight discomfort around the anus. However, each varies from the other in several aspects:

• Painful bowel movement: Main symptoms of anal fissures are severe pain during or maybe after the patient has passed a stool. The pain is sharp and sometimes may linger on for hours. Hemorrhoids, on the contrary, cause a dull aching kind of pain or discomfort. 
• Location: Anal fissures tend to feature at the back or front of the anus, while hemorrhoids tend to reside at or around the anus.
• Bleeding: This is one that sees the fissure bleeding bright red, while the blood is dropped during or after defecation. On the flip side, hemorrhoid bleeding comes mostly from straining and sometimes can be continuous. 
• Tear in the skin: You can perhaps see an anal fissure—sometimes more than one—a visible tear, or crack in the skin of the anus, but this will never be the case with hemorrhoids.

In cases where you are uncertain, it's best to consult with a doctor who can clinically diagnose you.

What is the Main Cause of an Anal Fissure?

The most common cause of an anal fissure is passing large and hard stools. When a person is either constipated or straining during bowel movements, the hard and dry stools stretch the vulnerable skin around the anus and cause a tear. Other causes include: 

• Having chronic diarrhea: If the patient is continually losing stools, then the skin of the anus is irritated and hence damaged, causing an anal fissure. 
• Childbirth: Women, recently giving birth, especially vaginally, may develop anal fissures because of physical strain while giving birth. 
• Anal intercourse: This may lead to injury to the delicate tissue surrounding the anus, which may lead to the progression of an anal fissure. 
• Inflammatory organisms: Diseases such as Crohn's that can maintain the inflammation in the GI tract may lead to a higher frequency of fissures. 
• Tight anal sphincter muscles: This could elevate the likelihood of tearing as a person has a bowel movement.

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How are Anal Fissures Diagnosed?

The diagnosis of an anal fissure is usually simple. The assessment, which involves physical examination, is performed based on history based on symptoms and past illnesses. 
The skin around the anus is assessed for any visible tear or crack. In certain cases, a digital rectal examination or a anoscopy, which is a small tube inserted into the anus to visualize the area better, will be performed. If the examiner believes that there may be a disease process going on such as Crohn's disease, any further testing might be performed: blood test, imaging, etc.

What Are Medical Treatments for Anal Fissures?

Typically, the management of anal fissure will focus on pain control and healing. In most cases, anal fissures will heal in 2-3 weeks with conservative therapies which may include:

• Topical medications: A numbing cream or ointment (i.e., lidocaine) may be applied to the area for pain relief.  
• Stool softeners: Stool softeners are effective at reducing straining by softening stool to provide some comfort.
• Warm sitz baths: Taking a sitz bath in warm water for 10-20 minutes may relax the anal muscles and allow for healing.
• Increased fiber intake: Foods high in fiber can help reduce straining and ensure your stools are not constipated.  
• Botox injections: For chronic fissures, particularly those that are more severe, botox may be injected with the effect of relaxing the sphincter to allow for healing.  

If conservative therapies are insufficient to heal a fissure, it may be appropriate for the patient to discuss surgical options.

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What can I do to avoid anal fissures? 

Although it may be impossible to prevent anal fissures all the time, some simple steps might reduce the chances, such as:

• Keep hydrated: Drink plenty of water to ensure stools remain soft.
• Eat a high-fiber diet: Plenty of fruits, vegetables, and whole grains should be consumed to keep constipation away.
•  Avoid straining: Don't put unnecessary pressure on the body for bowel movements. 
• Keep it clean: Cleanse around the anus gently after a bowel movement, but avoid rough wiping and soaps that can cause irritation.
• If necessary, use stool softeners: If you find yourself commonly constipated, you may want to consider using stool softeners after consulting with your doctor.

Conclusion

Anal fissures are often painful. There may be many causes such as constipation, diarrhea, and some lifestyle habits. The pain from these fissures has to adversely affect a person's life; however, correct management or treatment usually sorts these things out. 
At Rishabh Hospital, Jaipur, we are committed to caring for our patients with compassion and guiding every patient through personalized care and support so that they may recover. If you show some symptoms of an anal fissure, contact us at once for a consultation. Your comfort and well-being circle our center of attention.