Anal fissure

What is an anal fissure?
An anal fissure (fissures) is a tear or crack in the lining of the anal canal (anus), which causes extreme pain during bowel movements. Anal fissures affect everyone, from men and women to young and old people. It is the most common cause of rectal bleeding in infancy. A fissure tends to occur when passing hard or large stools during a bowel movement. There may also be spasms in the ring of muscle at the end of the anus.

What is the cause of an anal fissure?
Common causes of an anal fissure include passing large stools, constipation and straining during bowel movements, chronic diarrhoea, inflammation of the anorectal area and childbirth. The less common causes of anal fissures include anal cancer, HIV, tuberculosis, syphilis and herpes.

What are the symptoms of an anal fissure?
The symptoms of an anal fissure include:

  • Pain, which can sometimes be severe during bowel movements
  • Pain after bowel movements
  • Blood on the stool or toilet paper
  • Itching or irritation around the anus
  • A visible crack in the skin around the anus
  • A small lump on the skin near the anal fissure

How is an anal fissure treated?
An anal fissure will often heal within a few weeks if the stool is kept soft through increasing the intake of fibre and fluids. Soaking in a warm bath for 10 to 20 minutes daily, especially after toilet use, helps to relax the sphincter and helps it to heal. A doctor may recommend topical anaesthetic creams for pain relief. A Botox (Botulinum toxic type A) injection can paralyse the anal sphincter muscle and aids in relaxing spasms. Blood pressure medications can also help relax the sphincter.

How to prevent an anal fissure?
By preventing constipation it may help in preventing an anal fissure. Constipation can be prevented when eating high-fibre foods, drinking water and regularly exercising to stop from straining during bowel movements.

Risk factors for developing an anal fissure

  • Infancy – experts are not sure why but many infants experience an anal fissure during the first year of their life.
  • Aging – as an adult ages there is a decrease in circulation and blood flow to the rectal area.
  • Constipation – straining when trying to pass hard stool can increase the risk of tearing.
  • Childbirth – anal fissures become common in women after they give birth.
  • Crohn’s disease – the inflammatory bowel disease causes chronic inflammation of the intestinal tract and this makes the lining of the rectum vulnerable to tearing.
  • Anal intercourse.  
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