Summary about Disease
An anal fissure is a small tear in the lining of the anus. It causes pain during bowel movements and is often accompanied by bleeding. While often acute and self-limiting, chronic fissures can require medical intervention.
Symptoms
Severe pain during and after bowel movements
Blood on the stool or toilet paper
A visible crack in the skin around the anus
A small lump or skin tag near the anal fissure
Spasm in the anal sphincter muscles
Pain that can last for several hours after a bowel movement
Causes
Passing large or hard stools
Chronic constipation
Straining during bowel movements
Diarrhea
Anal sex
Childbirth
Underlying medical conditions like Crohn's disease (less common)
Tight or spastic anal sphincter muscles
Medicine Used
Topical Anesthetics: Lidocaine ointment to numb the area and relieve pain.
Topical Nitroglycerin: To relax the anal sphincter and promote blood flow.
Calcium Channel Blockers: Diltiazem or nifedipine cream to relax the anal sphincter.
Stool Softeners: To make bowel movements easier.
Botulinum Toxin (Botox) Injections: To paralyze the anal sphincter temporarily, reducing spasm.
Pain Relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen can help with pain management.
Is Communicable
No, anal fissures are not communicable. They are not caused by an infection that can be spread from person to person.
Precautions
Increase Fiber Intake: Eat plenty of fruits, vegetables, and whole grains to prevent constipation.
Stay Hydrated: Drink plenty of water to keep stools soft.
Avoid Straining: Do not strain during bowel movements.
Use Stool Softeners: If necessary, use stool softeners to make bowel movements easier.
Practice Good Hygiene: Gently clean the anal area after bowel movements.
Sitz Baths: Soak in warm water several times a day to soothe the area and promote healing.
How long does an outbreak last?
Acute Fissures: Usually heal within a few weeks with conservative treatment.
Chronic Fissures: Can persist for more than 6-8 weeks and may require more aggressive treatment, including surgery.
How is it diagnosed?
Physical Examination: A doctor can usually diagnose an anal fissure by visually inspecting the anus.
Medical History: The doctor will ask about symptoms, bowel habits, and any underlying medical conditions.
Anoscopy: In some cases, an anoscope (a small, lighted tube) may be inserted into the anus to visualize the fissure more clearly.
Sigmoidoscopy or Colonoscopy: These procedures are rarely needed but may be performed if there is suspicion of an underlying condition like Crohn's disease or if other symptoms are present.
Timeline of Symptoms
Initial Injury: Sharp pain during and immediately after a bowel movement.
First Few Days: Pain subsides somewhat between bowel movements but returns with each movement. Bleeding may be present.
Within Weeks (Acute): With treatment, pain gradually decreases, and bleeding stops as the fissure heals.
Chronic (Beyond 6-8 weeks): Persistent pain, continued bleeding, potential development of skin tag or fibrosis around the fissure. Pain is often more consistent and less tied to bowel movements.
Important Considerations
Underlying Conditions: Rule out other potential causes of anal pain and bleeding, such as hemorrhoids, infections, or inflammatory bowel disease.
Chronic Fissures: Chronic fissures can be more difficult to treat and may require surgery.
Sphincter Spasm: Addressing anal sphincter spasm is crucial for healing.
Patient Compliance: Following dietary and lifestyle recommendations is important for preventing recurrence.
Seek Medical Advice: If symptoms persist or worsen, seek medical advice for proper diagnosis and treatment.