What is an anal fissure?
An anal fissure means a tear in the anus lining or the anal canal lining. The anal canal is the opening via which stool releases from the body. This condition may be painful and might bleed. Anal fissures occur in babies and females after childbirth. Read this article to know about anal fissure treatment along with its causes.
What are its causes?
Anal fissures might result due to trauma to the anus and anal canal. This trauma may result due to one or more of these factors:
- Long-term diarrhea
- Prolonged constipation
- Addition of foreign items into the anus
- Straining to have a bowel movement, particularly if there is a hard, dry, or large stool
- Anal sexual activity, or anus elongation
Causes except trauma can be:
- Damaged anorectal region
- Decrease in the blood flow to the anorectal region
- Long-lasting poor bowel habits
- Any underlying health issues. These can be Crohn’s disease, ulcerative colitis, leukaemia, or anal cancer. Also, infectious conditions like tuberculosis and STDs include Chlamydia, syphilis, HIV, and gonorrhoea.
- Constricted or spastic anal sphincter muscles. These are the muscles regulating the closure of the anus.
What are the signs and symptoms of anal fissures?
Anal fissures result in strong pain. This painful sensation begins with the passage of stool. This pain might persist for several minutes to some hours. A lot of patients might try not to experience bowel movements. This may avoid the painful sensation.
Other signs can be:
- Blood spots on the toilet paper following a bowel movement.
- Small protuberances or skin tags on the skin adjacent to the anal fissure (frequently occur when chronic or when above six weeks).
What are the risk factors for anal fissures?
Factors that might enhance the risk of an anal fissure can be:
- Age. Anal fissures might happen at any age. However, they are more common in infants and middle-aged adults.
- Childbirth. This problem is more common in females after they conceive.
- Anal intercourse
- Crohn’s disease. This inflammatory fissure results in chronic inflammation of the gastrointestinal tract. And, this might increase the susceptibility of the anal canal lining to tearing.
- Constipation. The passage of hard stools enhances the risk of tearing.
What are the Anal Fissure Treatment options available?
Non-surgical Treatment
The concerned healthcare provider would discuss the benefits and side effects of treatments. Treatment may include:
- Intake of more water to aid the prevention of hard stools and help in the healing process.
- A high-fibre diet and OTC fiber supplements (doses around 25 to 35 grams of fiber per day). This helps to make stools soft, bulky and shaped.
- Warm tub baths for 10 to 20 minutes daily (particularly after bowel movements). This helps in relaxing the region and soothing the anal sphincter muscles. This aids in the healing process.
- Avoid using narcotic pain relievers. These medications may bring about constipation which might make the state worse.
- Medicines including lidocaine are useful for relieving pain. People can apply it to the skin around the anus.
- OTC stool softeners help to make stools easier to pass.
- Medicines including nifedipine, or nitroglycerin ointment relax the anal sphincter muscles. This aids in the healing process.
Surgical Treatment
Even if, many anal fissures do not need surgery, chronic fissures are difficult to treat. Surgery might be a better alternative. The goal of surgery is to aid the relaxation of the anal sphincter muscles. And, this helps to decrease pain and spasms, permitting healing of the fissure. Surgical alternatives may include Botulinum toxin (Botox) injection. People administer it into the anal sphincter or through surgical division of the internal fragment of the anal sphincter. The procedure is known as lateral internal sphincterotomy. Surgeons specialized in the colon and rectal fields might find the best treatment for the patient. And, they talk about the risks of surgery with him or her. Both forms of surgery are performed as same-day outpatient procedures.
Post-Anal Fissure Treatment Prognosis
Many patients resume their work and return to daily activities some days after surgery. Complete healing following both surgical and medical treatments might take 6-10 weeks. Even with the reduction of pain and bleeding, it is vital to maintain good bowel habits and have a high-fiber diet. Constant hard or loose bowel movements, blemishing, or spasms of the internal anal muscle might delay the healing process.
- Botox injections are linked with the healing of long-term anal fissures in 50% to 80% of patients.
- Sphincterotomy is efficacious in over 90% of patients. Even if it is unusual, this procedure might have an effect on the patient’s capability to completely control gas or bowel movements.
- Fissures frequently come back. A completely healed fissure might come back following trauma or hard bowel movement. Medical issues including infections, inflammatory bowel disease (Crohn’s disease), or anal tumors might result in signs like anal fissures. If a fissure fails to improve with treatment, its assessment for other likely conditions becomes important.
Can anal fissures be prevented?
In infants, fissures can be prevented by:
- If constipation seems to be the cause, it is better to treat it.
- Change diapers often.
In adults, fissures can be prevented by:
- Keeping the anorectal region dry.
- Treating all incidences of diarrhea and constipation on time.
- Wiping the region using soft materials, a wet cloth, or a cotton pad. Do not use rough or fragrant toilet paper.
- Avoid irritating the rectum.
Lifestyle and natural remedies
If a person has an anal fissure, it is important to exercise some precautions to avoid it from worsening and avoid reappearances:
- Take all drugs as per the doctor’s prescription.
- Get the suggested quantity of fiber in the diet. Avoid constipation or hard bowel movements. Foods containing rich amounts of fiber can be fruits, veggies, nuts, and whole grains. Incorporating fiber might also result in gas and bloating, so enhance the intake slowly.
- Drink a sufficient amount of water. This helps in hydrating and preventing constipation.
- Refrain from spicy food items in case of anal fissure. As these foods might worsen the signs.
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