It is a tear or division in the lining of the anal mucosa. Symptoms and signs include pain when a bowel movement occurs and bright red blood from the anus.
The problem is common in children under one year old and affects about eight in 10 babies. The susceptibility of a person to anal fissures tends to decrease with age. Common causes in adults include constipation and trauma to the anus (such as a difficult delivery).
About half of the cases are cured alone with self-care and avoiding constipation. However, healing can be a problem if the pressure of bowel movements constantly reopens the fissure. Treatment options include surgery.
Symptoms of fissure in the anus
Symptoms and signs of a fissure in the anus may include:
- Anal pain
- Pain when passing a movement and during a time later.
- Bright red blood of the anus.
- Blood on the surface of the stool.
- Blood stains on toilet paper.
Function of the anus
The anus allows intestinal continence, which is the voluntary control of the passage of bowel movements. The waste is massaged along the large intestine by waves of muscle contractions (peristalsis). Once the excess water is removed, the waste is temporarily stored in the rectum.
The rectum is attached to the anus, which is a short tube containing a muscular ring ( sphincter ) that can be opened at will to allow the expulsion of stool. The membranous lining of the anus is called anal mucosa.
An anal fissure is a tear in the anal mucosa.
Some of the causes include:
- Chronic constipation
- A rough or excessive cleaning of the anus.
- Inflammation of the anus and rectum.
- Crohn’s disease .
- Scratching (as a reaction to infection with pinworms, for example).
- Anal injury
- The pregnancy.
- Rectal cancer.
Complications of the fissure in the anus
Anal fissures are not associated with more serious diseases, such as bowel cancer , although anal cancer can mimic an anal fissure. Some of the possible complications of an anal fissure include:
Chronic anal crack: the tear does not heal. Over time, this can cause extensive scar tissue at the site of the fissure (sentinel pile).
Anal fistulas: anomalous “tunnels” join the anal canal with the surrounding organs, usually other parts of the intestine.
Anal stenosis: the anal canal narrows abnormally due to the spasm of the anal sphincter or the contraction of the resulting scar tissue.
An anal fissure is diagnosed using a series of tests that include:
- Physical exam.
- Inspection of the anus and rectum with a thin instrument (anoscope).
Treatment for anus fissure
Medical treatment for an anal fissure may include:
- Medication to relieve pain.
- Anesthetic creams
- Nitroglycerin creams or Botox injections to relax the associated muscle spasm.
Surgery for anal fissures:
Severe anal fissures should be corrected surgically.
The fissure and associated scar tissue are removed. Sometimes, a thin portion of the anal sphincter muscle is also removed , as this helps the wound heal better. (Cutting and suturing this muscle does not interfere with the control of the patient’s sphincter).
The operation, called lateral internal sphincterotomy, can be performed with local anesthesia. About nine out of 10 people will never experience another anal fissure.
Self-help for anal fissures:
Be guided by your health professional, but general suggestions include:
- Apply petroleum jelly at the anus.
- Consult your chemist for advice on specific ointments for anal pain.
- Take regular seat baths (salt baths), which involves sitting in a shallow bath of warm water for about 20 minutes.
- Use baby wipes instead of toilet paper.
- Take a shower or bathe after each bowel movement.
- Drink six to eight glasses of water every day.
Many cases of anal fissures are caused by chronic constipation. Suggestions include:
- Eat a diet high in fiber.
- Drink plenty of water to help soften the stool.
- Consider using a fiber supplement (such as Metamucil).
- Be sure to clean gently after going to the bathroom.
Things to remember
- The stools are stored temporarily in the rectum and are expelled from the body through the anus.
- An anal fissure is a tear or split in the lining of the anus (anal mucosa).
- Symptoms include pain and bright red blood from the anus.
- Treatment options include laxatives and surgery.
- Self-help suggestions include switching to a high fiber diet and drinking lots of water.
- Cancer of the anus can mimic an anal fissure.