Anorectal Care

Anal fissure

 

What is an anal fissure?
When you pass stool that is too hard or too large, a small tear may occur in the lining of the anal canal, known as an anal fissure. This could bleed and be very painful, but most of these heal without surgery; topical creams or suppositories can be used to provide relief. Anal fissures that fail to heal may become long term and cause significant irritation.

What are the symptoms of anal fissure?
Indications of having an anal fissure include itching or irritation around the anus, discomfort during bowel movements that eases until the next bowel movement, and blood on the outside of the stool, on toilet paper, or wipes.

What is the cause of anal fissure?
Anal fissure can be caused by a number of things, such as the following:

• Large or hard stool passing through the anal canal
• Constipation and straining during bowel movements
• Inflammation of the anorectal area
• Anal sex, although this is less common

What can you do before seeing a doctor?
It is important that you take steps to avoid constipation. Along with adding fiber to your diet, make sure to consume enough water and exercise regularly. Do not strain during bowel movements because the extra pressure could make the tear worse or even create another one.

How does the doctor make the diagnosis?
Your doctor will do a physical exam. Whether or not you undergo a rectal exam is up to you since it may be too painful. However, once your anal fissure has healed or if you've ever had rectal bleeding, your doctor may recommend further testing to make sure no underlying disorder caused your anal fissure.

How do you treat an anal fissure?
Acute anal fissures are fairly common and usually heal without treatment or with nonsurgical treatments. They may go away within two weeks. But if the tear doesn't heal within six to eight weeks, you may need surgery for chronic anal fissure.

Nonsurgical treatments
The following nonsurgical treatments are available if other methods don't work:

• Medicated creams or suppositories. A rectal corticosteroid (Anusol, others) or an over-the-counter cream containing hydrocortisone (Cortaid, Preparation H) may be prescribed to help reduce inflammation and ease discomfort.
• Other nonsurgical therapies. Applying blood pressure medication to the anus, which widens blood vessels and increases blood flow to the tear, may help it heal. It also helps reduce pressure in the anal sphincter, which eases the spasm and decreases pain.

Another treatment involves injecting a small amount of Botox into the internal anal sphincter. Botox paralyzes the muscle for up to three months, causing the spasm to relax, but temporary mild leakage of gas or stool may occur as a side effect.

Surgery
If you have a chronic anal fissure that won't heal on its own, surgery will most likely be the next option. The surgery, called partial anal sphincterotomy, may involve cutting a segment of the anal sphincter muscle to reduce spasm and promote healing, and may also include removing the fissure and any scar tissue resulting from it. Although rare, cutting the anal sphincter may lead to loss of ability to control bowel movements.

To help stop irritation and recurrences, as well as promote healing, you should increase fiber intake, drink enough fluids, exercise regularly, take baths, and avoid straining during bowel movements.