Navigating Anal Fissures: Things to Know

Anal fissures can be a pain in the butt (literally). Read on to know about their symptoms, causes, treatment and how to prevent them.

What is an anal fissure?

An anal fissure is a small tear in the lining around the anus. It can cause severe pain and may also lead to bleeding during bowel movements. While it can affect people across all age groups, it is more common in infants and middle-aged individuals.

What is an acute and chronic anal fissure?

Depending on the duration, anal fissures can be acute (recent onset) or chronic (lasting more than 8 weeks). Acute fissures resemble simple tears, while chronic ones may appear swollen, with scar tissue and fleshy growths.

What are the common causes of anal fissures?

These are typically caused due to some kind of trauma to the anus, usually seen with:

  • Chronic constipation or straining during bowel movements
  • Passing dry, large or hard stools
  • Chronic diarrhoea
  • Anal intercourse
  • Trauma during childbirth

Other less common causes include:

  • Inflammatory bowel disease
  • Anal cancer
  • Sexually transmitted infections (for eg. HIV, syphilis and herpes)
  • Tuberculosis

What are the risk factors for anal fissures?

Some conditions that can put you at a greater risk include:

  • Constipation
  • Childbirth
  • Crohn’s disease
  • Anal intercourse
  • Age (infants and middle-aged individuals)
Anal Fissure

What are some symptoms of anal fissures?

You may experience the following symptoms:
  • Severe, sharp pain while passing motion
  • Bright red blood in stools
  • Crack or breakdown in the lining of the skin around the anus
  • Small lump on the skin in the anal area
  • Burning or itching in the anal region

How is an anal fissure diagnosed?

Your doctor will ask you about your symptoms and your bowel movements. They will do a gentle examination of the area around the anus. In case of any suspected underlying condition, they may further carry out:

  • Anoscopy: A short device is inserted into the anus to visualise the anus and the lower rectum
  • Proctoscopy: A short rigid tube is inserted into the anus to inspect the anus and the rectum
  • Flexible sigmoidoscopy: A long flexible tube with an attached video camera is inserted to examine the rectum and lower portion of the colon
  • Biopsy: A part of the tissue around the area involved is removed and taken for examination

How do you treat an anal fissure?

This condition can be extremely painful. Your doctor will recommend medicines that help relieve the pain and promote healing, such as:

  • Simple painkillers such as paracetamol or ibuprofen
  • Topical anaesthetic creams that you can apply directly on your anus to counteract the pain
  • Laxatives to help you pass motions more easily
  • Topical Nitroglycerin ointment that you can directly apply to the affected area. This increases blood flow to the affected area and promotes healing
  • Calcium channel blockers (CCBs) usually used to treat high blood pressure, can increase the blood supply to the anal sphincter and help it relax
  • Botox injections (botulinum toxin) which paralyse your anal sphincter muscle and prevents it from spasming
  • In case of a non-healing or chronic anal fissure, your doctor may recommend surgery. A procedure called lateral sphincterotomy is usually performed. A small incision is made into the muscle surrounding the anal sphincter which can help reduce pain, promote healing and decrease your chances of getting them in the future.

What is the post-op recovery period of fissure surgery?

It can take anywhere between 2-4 weeks to completely heal. The pain usually subsides after a couple of days and most people can resume their day-to-day activities within a few days after the surgery.

Are there any side effects post-surgery?

Very rarely, you may experience side effects that usually resolve on their own after a few weeks. These include:

  • Minor faecal incontinence, where you may temporarily lose control over your bowel movements
  • Flatulence or passing gas involuntarily

What are some complications of anal fissures?

Complications include:

  • Persistent pain
  • Difficulty passing motions or altered motions
  • Decreased quality of life
  • Recurrence
  • Extension of the tear to surrounding muscles

Can an anal fissure go away on its own?

Acute fissures may heal on their own, while chronic ones may require medications or surgery.

What happens if an anal fissure is untreated?

Left untreated, these may become chronic, thus making them more difficult to treat. They lead to chronic pain, discomfort and a decreased quality of life.

Can an anal fissure return after healing?

While the recurrence rate after healing is high, you can certainly prevent it by adopting certain lifestyle changes.

How can I naturally prevent anal fissures?

Preventive measures include:

  • Staying well hydrated
  • Consume a fibre-rich diet with lots of fresh fruits and vegetables, wholewheat grains such as brown rice, oats, ragi, millets etc.
  • Avoid straining while passing motion
  • Keep your anal region as clean and dry as possible
  • Avoid any over-the-counter creams and ointments unless specifically recommended by your doctor
  • Regularly exercise at least 2.5 hours a week

My anal fissure is not healing. What should I do?

If there is no improvement even after 8 weeks of treatment, it may require further evaluation by your doctor.

Can an anal fissure lead to colon cancer?

While they generally do not lead to cancer, it is important to get evaluated by a doctor in case of a prolonged or non-healing fissure since misdiagnosis can lead to other serious conditions.

What is the difference between anal fissures, fistulas and piles?

Piles or haemorrhoids are swollen blood vessels in the anus, anal canal or rectum. They are usually painless in the initial stages and may be unnoticeable. An anal fistula is a tunnel or tract that runs between the anal canal and the skin. It is associated with pus from the anal area. You can differentiate between the three conditions based on the symptoms you are experiencing. All of them can be prevented through lifestyle modifications such as eating a fibre-rich diet and increasing your fluid intake.
Dr. Aditi

Dr. Aditi

An MBBS and a medical reviewer with a penchant for healthcare articles and blogs. Read her contributions and writings about various healthcare topics.

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