Learn about anal fissures and how to treat them.

Anal Fissures

If you have an anal fissure, you most likely will know it. Anal fissures are tears in the sensitive thin mucus tissue of the anus which causes pain, bleeding during bowl movements and spasms in the anal sphincter.

While uncomfortable and painful, anal fissures usually get better with simple treatments and with time. They occur often in young children, but can affect any person of any age and are usually caused when a person passes a significantly large or hard stool.

No one wants to deal with the pain of an anal fissure. Read on to learn more about this common pain in the… well, rear.

What Is an Anal Fissure?

An anal fissure is a tear in the anoderm, or the skin lining the anal canal. Anal fissures are one of the most common benign anorectal conditions and was first described in 1934 by Lockhart–Mummery.

"Most patients presenting with an anal fissure commonly complain of pain during the passage of the bowel movement. The pain is often sharp, severe and often described as a feeling of ‘passing razor blades’ or ‘passing shards of glass,’” said Carrie Geurts, MS, APRN, CNP, a board-certified nurse practitioner with INTEGRIS Colon and Rectal Surgery .
“It is most usually caused by trauma to the skin around the anal canal during the passage of a hard or large stool."

Signs and symptoms of an anal fissure include sometimes severe pain during bowel movements, pain after bowel movements that can last up to several hours, a visible crack around the anus, a small bump on the skin near the anal fissure and bright red blood on the stool or on the toilet paper.

Causes of Anal Fissures

The causes of fissures range from common mistakes like straining too hard while on the toilet to more serious reasons. The most common causes of anal fissures include passing hard stools, childbirth, constipation, anal intercourse and chronic diarrhea.

Though rare, anal fissures can also be caused by a more severe underlying condition such as Crohn's disease, HIV, anal cancer, syphilis, tuberculosis or other digestive diseases.

How Is It Diagnosed

An anal fissure is diagnosed by a simple exam looking carefully at the skin surrounding the anal canal. Oftentimes patients are afraid to seek medical care due to the fear of pain during the exam, but anal fissures are usually visible without requiring a rectal exam or other invasive testing.

If patients have fissures that are not in the midline — that is, toward the middle of the anal canal — or they have multiple, recurrent fissures, they may require more testing, such as a colonoscopy to rule out underlying Crohn's disease.

Anal fissures are usually initially treated by primary care providers, gastroenterologist, general surgeons and colorectal surgeons

What Are the Treatments for Anal Fissures?

Anal fissures are best treated by increasing fiber in the diet to around 35 grams a day. Fiber is important because it helps increase both the weight and size of your stool and softens it as well, making it easier to pass. Fiber supplements may also be useful.

If you have an anal fissure, a warm sitz bath can help relax the sphincter muscles, reducing pain and increasing blood supply to the fissure. Topical analgesics such as lidocaine may also be prescribed.

The initial first-line treatment may also include a topical cream that is designed to help relax the anal sphincter muscle which allows better blood supply in order for the fissure to heal.

Anal fissures that are chronic or do not respond to topical creams and ointments may require a quick, relatively painless, minor surgical procedure to remove the fissure and relax the sphincter muscle.

How Can I Reduce My Risk for an Anal Fissure?

The best way to avoid fissures is to eat a diet high in fiber, and the best way to add fiber to your diet is by eating plenty of green, leafy, plant-based foods and whole grains. Be sure when increasing fiber in your diet that you also drink plenty of fluids to help avoid constipation side effects.

Try not to strain when having a bowel movement. Straining can increase pressure, which can open a healing tear or cause a new tear on the anus.

For infants with an anal fissure, change diapers frequently and keep the area clean with a gentle washing.

For more information or if you think you may have an anal fissure, contact your INTEGRIS Health physician today.

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