An anal fissure is a tear in the lining of the anus or anal canal. The anal canal is the last part of the large intestine between the rectum and anus. This common condition affects men and women equally and both young and old people. Fissures are very common in babies 6 to 24 months old and during pregnancy.
The usual cause is passing large, hard stool. Constipation and straining during bowel movements can also cause it. Another cause is inflammation of the anus and rectum. Crohn’s disease and inflammatory bowel disease can also cause this inflammation. Risk factors include frequent bowel movements, diarrhea, infections, cancer and trauma. Examples of infections causing anal fissures are syphilis, gonorrhea, herpes simplex virus, and HIV. Trauma may be from surgery or anal sex. Older people may have anal fissures partly because of straining when moving bowels due to constipation and poor blood flow to the area. Anal fissures are also common in women after childbirth.
The main symptoms are sharp, burning, or tearing pains that are made worse by bowel movements. Bright-red blood on toilet paper and on the stool or in the toilet water is another. Other problems include itching, discomfort, or cracks in the skin around the anus.
The health care provider makes a diagnosis from the medical history and physical examination, including a digital rectal examination. The health care provider may order laboratory tests and colonoscopy to rule out similar diseases. Colonoscopy involves using a flexible tube (colonoscope) with a lighted tip to look inside the colon. Biopsy and tests for infections may be done. A specialist (colorectal surgeon) may be seen.
Anal fissures usually heal without treatment or with nonsurgical treatments. The main forms of treatment are stool softeners (docusate), sitz baths, and other lifestyle measures. These measures also include eating a high-fiber diet, increased drinking of fluids, and getting regular exercise. A local anesthetic jelly or nitroglycerin ointment may be applied to the anus. In resistant cases, botulinum toxin may be injected into each side of the internal anal sphincter muscle. This method helps heal chronic anal fissures in more than 90% of people. Most people improve in a few days with treatment. If conservative therapies don’t work in 4 to 6 weeks, surgery can be done. It’s usually done on an outpatient basis.
Keep the anal area dry. For babies, changing diapers regularly and keeping the anal area clean are important.
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