A small tear in the moist tissue lining of the anus or lower rectum is known as an anal fissure. Anal fissures typically produce symptoms that last six weeks or less, but are considered a chronic medical issue if they persists beyond this timeframe. Chronic anal fissures are typically indicative of an underlying colorectal condition and may be more difficult to treat.
Causes of an Anal Fissure
Anal fissures are common in infants, but they may occur at any age. The risk of developing an anal fissure typically decreases with age, but once you develop one anal fissure you are at an increased risk for developing the condition again.
Anal fissures are typically caused by trauma to the anus or anal canal, but may also be related to non-traumatic factors. One or more of the following may cause an anal fissure:
- Chronic diarrhea
- Chronic constipation
- Anal sex or stretching of the anus
- Insertion of foreign objects into the anus
- Straining against large, hard or dry bowel movements
- Anorectal scarring
- Poor bowel habits
- Diminished blood flow to the affected area
- Excess tension in the sphincter muscles that control the anus
- Underlying medical conditions like inflammatory bowel disease, sexually transmitted diseases, anal cancer, leukemia and infectious diseases.
Anal Fissure Symptoms
If you experience an anal fissure, you may feel a slight ripping or splitting sensation during bowel movements. In addition to this sensation, you may also notice:
- Pain during (and sometimes hours after) bowel movements
- Blood on used bathroom tissue
- Blood on stool surface
- Bleeding that discolors water in toilet
- Visible tear in the anus
- Malodorous discharge
- Burning, itching and irritation around the anus
- Frequent urination, urinary incontinence or discomfort during urination
Diagnosing an Anal Fissure
Your colorectal specialist, formerly known as a proctologist, will typically be able to diagnose an anal fissure by visually inspecting the anus or performing a general physical examination. However, more testing may be required if your surgeon suspects another colorectal condition may have contributed to the anal fissure.
If diagnosis is still unclear after a physical exam, your colorectal specialist may recommend a flexible sigmoidoscopy to examine the lower part of the colon. Your colorectal specialist may also recommend a colonoscopy in order to further inspect the large intestine. Both tests include the insertion of a thin, flexible scope equipped with a light and camera to view the inside of the colon. Such tests are commonly used to identify inflammatory conditions and abnormal growths.
Treating an Anal Fissure
An anal fissure will typically heal on its own and require no additional treatment. If an anal fissure does not heal on its own, the following conservative treatments may be employed before surgical intervention is needed:
- Sitz baths
- Stool softeners
- Dietary adjustments
- Application of creams, ointments or topical muscle relaxants
- Avoidance of excessive straining and sitting during bowel movements
Patients suffering from anal fissures for longer than six weeks without response to medical treatment may need surgical intervention. A surgical procedure known as a lateral internal sphincterotomy helps relax the internal anal sphincter, reducing pain and spasms which gives the anal fissure the opportunity to heal. Lateral internal sphincterotomy is performed under sedation and typically is performed as an outpatient procedure. Patients can expect to return to normal activity within one week.