Anal fissure
An anal fissure is a small tear in the thin, moist tissue mucosa that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. A small tear in the lining of the anus.
The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times the fissure can be deep enough to expose the muscle tissue underneath. An anal fissure usually isn't a serious condition. It can affect people of all ages, and it's often seen in infants and young children since constipation is a common problem in these are groups.
In most cases, the tear heals on its own within four to six weeks. In cases where the fissure persists beyond eight weeks, it's considered chronic.
Symptoms of fissure:
- A visible tear in the skin around your anus.
- A skin tag, or small lump of skin, next to the tear
- Pain, sometimes severe, during bowel movements
- Sharp pain in the anal area during bowel movements
- Streaks of blood on stools or on toilet paper after wiping
- Burning or itching in the anal area
- Pain after bowel movements that can last up to several hours
- Bright red blood on the stool or toilet paper after a bowel movement
- A visible crack in the skin around the anus.
Causes:
Anal fissure most often occurs when passing or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around your anas. Some other common causes include:
- Straining during childbirth or bowel movements
- Inflammatory bowel disease (IBD), such as Crohn's disease
- Decreased blood flow to the anorectal area
- Overly tight or spastic anal sphincter muscles
Some rare causes:
- Anal cancer
- HIV
- Tuberculosis
- Syphilis
- Herpes
Risk factors:
- Constipation: Straining during bowel movements and passing hard stools increase the risk of tearing.
- Childbirth: Anal fissures are common in women after they give birth.
- Age: Anal fissures can occur at any age, but are more common in infants and middle-aged adults.
- Crohn's disease: This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.
Diagnosis:
Medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible, usually, this exam is all that's needed to diagnose an anal fissure.
An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear and may have internal or external fleshy growths.
- Anoscopy: An anoscope is a tubular device inserted into the anus to help your doctor visualize the rectum and anus.
- Flexible sigmoidoscopy: The doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.
- Colonoscopy: The doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than 50 or you have risk factors for colon cancer, signs, of other conditions, or other symptoms such as abdominal pain or diarrhea.
Complications:
- Failure to heal: An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
- Recurrence: Once you've experienced an anal fissure, you are prone to having another one.
- A tear that extends to surrounding muscles: An anal fissure may extend into the ring of muscles that holds your anus closed (internal and sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.
Prevention:
Prevent anal fissure by taking measures to prevent constipation or diarrhea. Eat high fiber foods, drink fluids, and exercise regularly from having to strain during bowel movements.
- Keeping the anal area dry
- Cleansing the anal area gently with mild soap and warm water
- Treating diarrhea immediately
- Changing the infant's diapers frequently
Lifestyle and home remedies:
Lifestyle changes may help relieve discomfort and promote healing of anal fissure, as well as prevent recurrences.
- Add fiber to diet: Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts, and whole grains. You also can take a fiber supplement, Adding fiber may cause gas and bloating, so increase your intake gradually.
- Drink adequate fluids: Fluids help prevent constipation.
- Avoid straining during bowel movements: Straining creates pressure, which can open a healing tear or cause a new tear.
- If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently, and discuss the problem with your child's doctor.
If your stomach's been bothering you, our free guide can help you talk with your doctor to get the treatment you need.
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