Anal Fissure: Causes, Symptoms And Treatment Of Fissure

An anal fissure is a painful tear in the tissue of the anal canal. It usually affects the superficial layer (epithelium), but in patients with chronic anal fissures, deeper layers (mucosa) of the anal tissue may be affected too.

Anal fissures can occur in patients of any age. The treatment depends on the severity of the fissure. Mild to moderate cases are treated medically. However, in severe cases, surgical approaches can be adopted.

What Are The Causes Of Anal Fissures?

Most often, anal fissures occur due to trauma caused during the passage of, particularly hard stools.Low-fibre diets cause constipation, and therefore the patient strains more during bowel movements. This can also result in injury to the anal mucosa, which can cause fissures.Trauma during childbirth, chronic diarrhoea, previous anal surgery and anal intercourse are some of the less common causes of anal fissures.

What Are The Symptoms Of Anal Fissures?

Some of the most common symptoms of anal fissures include:

• Severe pain during a bowel movement. Pain may continue for several minutes or hours
• Visible tear in the skin surrounding the anus
• Recurring pain with every bowel movement, making the patient unwilling to pass stools, leading to further constipation
• Bright red blood on the toilet paper or stool
• Presence of a skin flap or tag near the anus

What Are The Risks Associated With Anal Fissures?

If left untreated, anal fissures can increase the risks of developing:

• Severe Constipation: As the pain from the fissure becomes unbearable, patients get discouraged from passing stools, and this worsens constipation.
• Fecal impaction: If the fissure causes narrowing of the anal canal, this can lead to hardened stools that get stuck in the rectum.
• Fistulas: These are abnormal connections that can form between the anus and the skin or intestines.
• Development of a skin tag or flap near the anus.

How Are Anal Fissures Diagnosed?

Diagnosis of anal fissures is done using manual examination as well as instrumental investigations.

Digital (using fingers or digits) rectal examination may be performed by the doctor to assess the depth and length of the anal fissure.

You may also be asked to undergo sigmoidoscopy or colonoscopy to visualise the fissure and imagining to assess the fistula.

Additionally, your doctor may also recommend routine blood tests to judge your overall health.

How Are Anal Fissures Treated?

Treatment of anal fissures is mainly medical. The main goal of the treatment of fissure is to relieve constipation and to reduce hard stools, as softer stools are less painful for the patient to pass.

Medical therapy involves:

• Bulking agents like fibre supplementation and stool softeners
• Laxatives to regularise bowel movements
• Mineral oils are used to make the passage of stool easier and to lubricate the anal canal
• Sitz baths can be taken after bowel movements to provide pain relief.

In some cases, doctors may prescribe certain ointments to be applied directly to the internal sphincter for relieving the pain. Botulinum Toxin injection may also be used to relieve spasms in the anal sphincter.

Topical anaesthetic creams may also be prescribed to be applied directly on the fissure in order to achieve pain relief.

Frequently Asked Questions (FAQs)

How do you treat an anal fissure?

Anal fissures are treated by using medications like topical pain-relieving creams, stools softeners and stool bulking agents.

What happens if a fissure goes untreated?

Leaving anal fissures untreated can result in an increased risk of complications like faecal impaction, severe constipation, or fistulas.

Will I need surgery to cure the fissure?

Surgery is indicated in patients in whom:

• Medical therapy failed to resolve the acute fissure.
• Symptomatic chronic fissures seldom heal spontaneously and therefore may need surgical intervention.

How much will a fissure doctor charge on a first visit?

A doctor’s consultation fees are extremely subjective and depend on the doctor you see.