Anal fissure is the tiny tear of the skin in and around the anus. Anus is the region through which feces are expelled from the body. Though the tear is lesser than one cm it causes pain while passing stool. Normally it takes about 1-2 weeks for the anal fissure to heal on its own. But in some people it takes more time than expected. This would cause sharp pain when the person makes bowel movement. Topical ointments are applied to relax the muscle surrounding the anus. In severe cases it has to be removed by surgery. Anal fissure is a simple problem but the pain it causes can be distressing.
Symptoms :
Anal fissure can cause sharp burning pain while making bowel movements. For some people pain can be very difficult to manage. The pain may last for few minutes to several hours. Anal fissure also causes bleeding while expelling feces. You can see red blood stains on the tissue paper. For some people it can be painful and itching around the anus region.
Causes :
The major cause for the formation of anal fissure is over stretching the muscles while passing stools. The skin around the anus would be so soft that it gets tear up while making bowel movements that are hard. The sphincter muscles around the anus are responsible for stretching and contracting the anus region while passing feces. The skin around this region will get damaged very quickly and it also heals quickly.
If the person has higher tone than normal pressure on the muscle it makes the muscles tighter causing anal fissure. It would also cut down the blood supply to the region slowing down the healing process. Over time, the pain becomes worse needing immediate treatment. Any trauma to the anal region can cause anal fissure. People having anal sex can develop this problem easily. Consistent constipation can lead to anal fissure. Similarly repeated diarrhea can also cause this problem. Anal fissure can also be caused due to Crohn’s disease.
Diagnosis :
Your doctor can detect anal fissure by physically examining the anus and rectal area.
Treatment (medical) :
Your doctor would prescribe cream or ointment that contains lidocaine to comfort the area and facilitate healing. Soaking the area in warm water can reduce pain and discomfort. Do not use lidocaine cream more than the prescribed days since it can cause skin irritation. For severe cases, cream containing steroid can be applied around the fissure. Steroids are effective in controlling inflammation and reduce itchy feeling.
Prescription medicines also include glyceryl trinitrate cream which can be applied on the anus area. It heals the area quickly and also increases blood supply. This is the best ointment for people with chronic (long term) fissure. Some doctors would give a shot of botulinum injection directly on the anal sphincter muscle for quick healing.
- Surgery :
For people who suffer from recurring fissure, surgery is the choice. The surgeon would make a small incision on the skin around the anus. This would reduce the pressure on the sphincter muscle which heals quickly. This process can be done by giving local anesthesia and the patient can get back home the same day.
Home Remedies :
Most of the time, anal fissure heals on its own without requiring any treatment. Avoid constipation and include high fiber diet daily. Eat lots of fruits, vegetables and cereals. Drink plenty of water and liquids which helps in softening the feces. Avoid taking alcohol since it can cause dehydration.
For people with repeated constipation you can include fiber supplements available in most of the drugstores. Taking methylcellulose would soften the feces so that you can expel them easily without much strain. You can also try laxatives like macrogol or lactulose. Whenever you get an urge to pass feces do not postpone it, since it makes the stool harder. You can try using sitz bath daily for 3-4 times. Sit relaxed on warm water tub for 10-15 minutes which is effective in soothing the torn skin.