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Anal Fissure

A thin, moist tissue called mucosa lines the anus. When this develops a tear, it’s called an anal fissure. When a person passes hard or large stools it can lead to an anal fissure, and cause pain and bleeding with bowel movements. The patient may also suffer from spasms in the anal sphincter, that is the ring of muscle at the end of the anus. 

If an anal fissure doesn’t heal within eight weeks it’s considered a chronic condition and should be attended to. Patients who have had an anal fissure are more prone to the same problem in the future.

In some cases, the anal fissure may extend into the ring of muscles that holds the anus closed, also called the internal anal sphincter. When this happens it becomes more difficult for the fissure to heal. The patient feels discomfort and requires treatment to reduce the pain and repair the fissure.

Risk of anal fissure

The following factors increase your risk of suffering from anal fissures: 

  • Constipation: People who are constipated may strain while passing bowels and have hard stools which increase the risk of tearing.
  • Childbirth: Women are at a higher risk of anal fissures after childbirth.
  • Crohn's disease: Crohn’s disease is an inflammatory bowel condition that causes chronic inflammation of the intestinal tract, and the lining of the anal canal more vulnerable to tearing.
  • Anal intercourse
  • Age: Anal fissures are more common in infants and middle-aged adults. They can affect others but are less common.

Causes of anal fissure 

Anal fissures are commonly caused by constipation and strain during bowel movements. Passing large or hard stools main cause such a tear. Chronic diarrhoea is also a cause of anal fissure. Anal intercourse could lead to fissure. Women could develop an anal fissure after childbirth. 

In some cases, an anal fissure may develop due to other health conditions such as Crohn's disease or inflammatory bowel disease, anal cancer, HIV, tuberculosis or syphilis. 

Symptoms of anal fissure

A person exhibiting the following signs and symptoms should consult a doctor to check whether an anal fissure has occurred:

  • Pain, that may be severe, during bowel movements, and possibly lasting for several hours later.
  • Bright red blood on the stools or toilet paper.
  • A tear in the skin around the anus.
  • A small lump or skin tag on the skin near the anal fissure.
  • Burning or itching sensation along with pain. 
  • Discomfort when urinating, frequent urination, or inability to urinate.
  • Foul-smelling discharge.

Diagnosis of anal fissure

When you visit a specialist at Medcare for treatment of anal fissure, the doctor will start by asking about your medical history and will perform a physical exam that will involve an inspection of the anal region. Quite often an anal fissure is visible to the eye so this exam is sufficient for diagnosis. An acute anal fissure appears like a fresh tear while a chronic one has a deeper tear and may have internal or external fleshy growths. 

If the fissure is on the side of the anal opening, rather than the back or front, it is more likely to be the sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she suspects an underlying condition. This testing may involve:

  • Anoscopy: This scope is inserted into the anus to help the 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 for patients younger than 50 and low-risk factors for intestinal diseases or colon cancer.
  • Colonoscopy: This enables the doctor to inspect the entire colon. This test may be done for patients older than 50 or those who have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhoea.

Treatment of anal fissure 

With lifestyle changes and home remedies, most anal fissures heal within some weeks or months. Treatment aims to reduce the pressure on the anal canal by making stools soft, ease discomfort and prevent bleeding. 

A conservative line of treatment is adopted first. 

  • Prevent constipation: This is important to reduce the strain on the anal canal. Increasing your intake of fluids is an important step to achieve this. Drink plenty of fluids throughout the day but avoid consuming too much alcohol or caffeine as these can lead to dehydration. Consuming a diet rich in fibre is also helpful to prevent constipation. You should try to eat about 20 to 35 grams of fibre every day. Wheat bran, oat bran, whole grains such as brown rice, oatmeal, and whole-grain pasta, cereals, and breads should be included in your diet. Peas, beans, citrus fruits, prunes and prune juice are also beneficial. You can also have fibre supplements as these help to soften stools and make your bowel movements more regular.
  • Laxatives: Ask your doctor about laxatives if necessary. 
  • Avoid sitting or straining on the toilet for long durations: This puts unnecessary pressure on the anal canal.  
  • Clean gently: Clean and dry the anal area after each bowel movement more gently. 
  • Treat chronic diarrhoea: If you suffer from chronic diarrhoea ask your doctor for the right treatment.
  • Sitz baths: This treatment involves sitting in a tub of warm water 2 to 3 times a day for 10 to 15 minutes each. This cleans the anus, improves blood flow and relaxes the anal sphincter.

If your baby has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your paediatrician. If the problem persists after these lifestyle changes and home remedies you may require medications or surgery for anal fissures. 

Medication: Your doctor may prescribe topical ointments or oral medication for the treatment of anal fissures.

Botox injections: The specialist at Medicare may recommend injecting Botox into the sphincter. These injections temporarily paralyze the sphincter muscle, giving relief from pain. They also help with healing in 60% to 80% of patients. 

Surgery: Your specialist may recommend surgery for the treatment of the anal fissure. This may be necessary when a fissure fails to heal because of scarring or muscle spasms of the internal anal sphincter muscle. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle. This helps to reduce pain and spasms and allow the fissure to heal. The procedure is called a lateral internal sphincterotomy (LIS). In most cases, the fissures are healed completely within 8 weeks after surgery.
 
For the right diagnosis and treatment of anal fissures schedule a consultation with a specialist at Medcare. 

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