Summary about Disease
An anal fissure is a small tear in the lining of the anus. It typically causes pain and bleeding during bowel movements. While often resolving on its own or with simple treatments, chronic fissures may require medical intervention.
Symptoms
Pain during bowel movements
Pain after bowel movements that can last several hours
Bright red blood on stool or toilet paper
Visible crack in the skin around the anus
A small lump or skin tag near the anal fissure
Causes
Passing large or hard stools
Chronic constipation
Straining during bowel movements
Diarrhea
Inflammatory bowel disease (IBD)
Childbirth
Anal sex (less common)
Medicine Used
Topical anesthetics: Lidocaine to relieve pain.
Topical corticosteroids: To reduce inflammation.
Calcium channel blockers (topical): Nifedipine or diltiazem to relax the anal sphincter.
Nitroglycerin (topical): To relax the anal sphincter.
Stool softeners: To prevent constipation.
Botulinum toxin (Botox) injections: To paralyze the anal sphincter (for chronic cases).
Pain relievers: Over-the-counter pain medications.
Is Communicable
Anal fissures are not communicable or contagious. They are not caused by an infection that can be spread from person to person.
Precautions
Increase fiber intake.
Drink plenty of fluids.
Avoid straining during bowel movements.
Use stool softeners if necessary.
Maintain good anal hygiene.
Sitz baths (soaking in warm water) can help soothe the area.
How long does an outbreak last?
Acute anal fissures typically heal within a few weeks with conservative treatment. Chronic fissures can last for more than 6-8 weeks and may require more aggressive intervention.
How is it diagnosed?
Physical examination: A doctor can usually diagnose an anal fissure by visually inspecting the anus.
Anoscopy: A short, lighted tube (anoscope) may be inserted into the anus to visualize the fissure more clearly, especially if deeper inside.
Sigmoidoscopy or Colonoscopy: Recommended if there is concern that another condition, such as inflammatory bowel disease, is causing the fissures.
Timeline of Symptoms
Initial stage: Sharp pain during and immediately after bowel movements.
Next stage: Pain may persist for several hours after bowel movements. Bleeding may occur.
Chronic stage: Cycle of pain, spasm of the anal sphincter muscle, and tearing with bowel movements. The fissure may not heal and can become deeper.
Important Considerations
Consult a doctor if symptoms persist or worsen.
Chronic fissures may require surgery (lateral internal sphincterotomy) to relieve pressure on the anal sphincter.
Rule out other possible causes of anal pain and bleeding, such as hemorrhoids or inflammatory bowel disease.
Pregnancy can increase the risk of anal fissures.
Children can also develop anal fissures.