Anal Fissures: Symptoms, Causes, Diagnosis, Treatment, and Risks

An anal fissure is a the tear or ulcer in the anal canal’s lining. The anal canal forms the end of the large bowel and lies between the rectum and the anus.

Symptoms of Anal Fissure

The following are the most prominent symptoms of anal fissures:

• A pricking pain when emptying the bowel, and then, an intense burning pain that develops and possibly persists for a couple of hours.
• Bleeding while emptying the bowel – Mostly, you'll see spots of blood in your stool or on your used toilet paper.

What Leads to Anal Fissures?

A damaged anal lining or canal usually leads to anal fissures. The majority of people who have anal fissures are those who are experiencing constipation and get tears in their anal lining caused by hard or large stools.

Anal fissures can also be caused by:

• Constant diarrhea
• Inflammatory bowel disease like Crohn's disease as well as  ulcerative colitis.
• Pregnancy as well as childbirth
• Sometimes, sexually transmitted diseases like syphilis or herpes, which can infect and cause damage to the anal canal.
• The anal region normally has tight sphincter muscles, which make the anal canal more prone to tearing, since muscles can cause increased tension in the area. 

When To Visit Your General Practitioner

If you experience any signs or symptoms of anal fissures and suspect you might have them, do visit your GP. You shouldn’t be too embarrassed to shy away from looking for assistance since anal fissure cases aren’t strange to your GP. A good number of people suffer from the condition, thus making it very common.

You will most likely recover from anal fissures even without using any medication. However, your GP will want to ascertain that you don’t have some other problem like hemorrhoids, which have the same symptoms.

Your general practitioner can also educate you on self-care tips and treatment methods that will help you recover and minimize the chances of the fissures’ recurrence.

People who are more vulnerable to the development of anal fissures 

• Infants: Although researchers haven’t found the reason behind it, many young babies have anal fissures in their first year of birth. 
• Elderly people: Intestinal problems, constant constipation, and poor circulation of blood in the anal region are the major causes of anal fissures in elderly people. 
• People with constipation: Persistent constipation and extreme strain increase the chances of having anal fissures.
• Women during childbirth: When a woman is giving birth, some parts near the anus may be torn, making her vulnerable to anal fissures. 
• People with Crohn's illness: This disease causes an inflammation of the colon, and the chances of injuries to the anal canal mucosa increase.
• People who participate in anal intercourse: During an anal intercourse, the rectal tissues become strained and traumatized, making the anal canal susceptible to anal fissures development. 

Anal Fissures Diagnosis

Your GP will want to know about the symptoms you are experiencing and the nature of your pain. They will also likely inquire about your toilet habits and behaviors. They will part your buttocks gently to check for fissures.

Your GP may also examine your rectum by gently inserting a lubricated, gloved finger into your anus, to feel any abnormality in your anal canal. This examination method isn’t common, since it is usually painful. 

A specialist’s examination may be required if your GP suspects that your fissure is a result of something serious. This examination may consist of a more comprehensive assessment of your anus and is normally done using an anesthetic to reduce pain. 

If fissures don’t go away after simple treatments, the pressure of your anal sphincter may be measured.

Anal Fissures Prevention and Treatment

Typically, an anal fissure does not require treatment and disappears within several weeks. However, untreated constipation can lead to recurring anal fissures.

Sometimes, anal fissures can be chronic, lasting for at least six weeks. You can relieve discomfort when passing stool by taking some simple self-help tips. These measures will help in healing the existing fissures and minimize the possibility of their recurrence in future.

The following self-care tips will help you avoid constipation:

• Eat plenty of foods that are rich in fiber, such as fruits, vegetables, whole wheat bread, oats, pasta, and rice. The minimum fiber intake for adults is at least 18 grams per day.
• Drink plenty of water to maintain proper body hydration.
• Don’t refrain from passing stool when you feel the urge to empty the bowel. Your stool can become drier and harder as a result of your failure to pass it.
• Exercise frequently - Make sure to get at least 2.5 hours of physical exercise per week.

Some painkillers (paracetamol or ibuprofen) are effective in reducing the pain associated with anal fissures. Alternatively, you can immerse your buttocks in a basin of warm water multiple times daily, particularly after defecating. 

Your GP may prescribe medication to make your symptoms less severe and help you recover faster. These medications may consist of laxatives (to promote easy passage of stool) and a painkiller in ointment form, which is applied directly to the anus.

In cases where anal fissure is chronic or recurrent and self-help measures and medication haven't helped, doctors may suggest surgery. 

Classification and Forms of Anal Fissure

Depending on what caused it, anal fissure can either be acute or chronic.

Acute anal fissure

This is the initial stage, wherein the anal canal mucosa becomes slightly damaged. People with acute anal fissure experience a strong but temporary pain. Normally, patients feel pain only when passing stool, and then it persists only for around 15 to 20 minutes. Bleeding at this stage is little.

If the acute anal fissure is not treated properly and persists, it becomes chronic. 

Chronic anal fissure

When the anal fissure turns chronic, the edges of the anus become compact, and thicken.

Chronic anal fissure is characterized by pain that not only occurs when stool is passed, but also when a patient strains to sit in a certain position. People with this condition dread visiting the toilet, and consequently resolve to use laxatives.  These patients normally become irritable and suffer from sleeplessness.

Areas commonly affected by anal fissures

The back anal margin is the part most vulnerable to fissure development. This is because blood isn’t supplied well to this region, aside from its susceptibility to trauma when stool passes. 

How to Prevent Anal Fissures

It isn’t always possible to prevent anal fissure. However, the following measures can prevent the condition from developing:

• Regular nappy change in the case of young babies
• Maintaining a dry anal region
• Using mild soap with warm water to gently cleanse the anal region
• Drinking plenty of fluids, eating foods rich in fiber, and exercising frequently to avoid constipation
• Seeking immediate treatment for diarrhea, if it occurs.

Complications

In rare cases, anal fissure causes complications. A crack may recur or refuse to heal and cause complications. A crack lasting for over one and a half months is considered chronic.

The crack, which affects the anal canal’s walls, slowly spreads to the rectum’s interior sphincter. As a result, spasm (an anal fissure’s compilation) occurs.

The walls around the anal fissure may also bleed. Also, an opportunistic infection may enter the mucosal crack in the anal canal, which can lead to the bleeding of the walls of the anal fissure, as well as an acute abscess.