Fissures are a common and often painful medical condition that can affect various parts of the body, but they most frequently occur in the skin or mucous membranes. A fissure is a small tear or crack in the skin or lining of a body part. The most commonly recognized fissures are anal fissures, which occur in the skin around the anus, but fissures can also appear in the lips, cornea of the eye, or the skin of the hands and feet. In this blog, we will focus on anal fissures, their causes, symptoms, diagnosis, and treatment options, while briefly exploring other common types of fissures.

What is an Anal Fissure?

An anal fissure is a small tear or crack in the skin around the anus. It can be an incredibly painful condition that often results from the passage of hard or large stools. The anal fissure affects the skin that lines the anus, causing discomfort or pain, especially during and after bowel movements. While anal fissures can occur in anyone, they are more commonly seen in infants, older adults, and people suffering from constipation or certain gastrointestinal conditions.

Causes of Fissures

Anal fissures can be caused by a variety of factors, many of which are related to trauma or pressure on the anal region. Common causes of fissures include:

1. Constipation: Chronic constipation, where a person struggles to pass hard or large stools, is one of the most common causes of anal fissures. The straining required to pass hard stools can cause the skin around the anus to tear.
2. Diarrhea: Diarrhea can also lead to anal fissures. Frequent bowel movements, especially if they are watery or forceful, can irritate and tear the delicate skin around the anus.
3. Childbirth: Women who experience vaginal delivery during childbirth may develop anal fissures due to the pressure exerted during delivery. The perineal area can be stretched or torn during this process, leading to fissures.
4. Anal Intercourse: Anal sex can sometimes cause trauma to the skin around the anus, leading to fissures, especially if there is inadequate lubrication or forceful penetration.
5. Inflammatory Bowel Disease (IBD): Conditions like Crohn’s disease and ulcerative colitis can cause inflammation in the gastrointestinal tract, which may contribute to the development of fissures.
6. Poor Hygiene: Poor personal hygiene, or over-aggressive wiping after bowel movements, can also contribute to the development of fissures by irritating the skin.
7. Other Medical Conditions: Conditions such as anal cancer or sexually transmitted infections (STIs) can sometimes lead to the development of fissures due to irritation or infection.

Symptoms of Fissures

Anal fissures can vary in severity, but they commonly present with a few hallmark symptoms. These include:

1. Pain during Bowel Movements: The most characteristic symptom of an anal fissure is pain during or after bowel movements. The pain is often described as a sharp, burning, or stinging sensation that can last for several minutes or longer.
2. Blood in Stool: You may notice small amounts of bright red blood on the toilet paper or in the toilet bowl after having a bowel movement. The blood usually comes from the torn skin around the anus.
3. Itching or Irritation: The area around the anus may become itchy or irritated due to the tear in the skin. This can worsen after bowel movements.
4. Visible Tear or Crack: In some cases, a visible tear or crack may be noticed on the skin around the anus. This tear can be shallow or deep, depending on the severity of the fissure.
5. Discomfort or Soreness: Persistent discomfort, tenderness, or soreness around the anus may be felt even after the bowel movement has passed.
6. Spasms of the Anal Sphincter: In some people, anal fissures cause spasms of the anal sphincter (the muscle that controls the opening and closing of the anus). This muscle spasm can make it even more difficult and painful to pass stools.

Diagnosing Anal Fissures

Anal fissures are typically diagnosed based on a physical examination by a healthcare provider. The doctor will examine the area around the anus and may ask the patient about their symptoms and medical history. The healthcare provider may also use the following methods to confirm the diagnosis:

1. Visual Inspection: A simple visual examination of the anus can often reveal the tear or crack in the skin that is characteristic of an anal fissure.
2. Anoscopy: An anoscope is a small, tube-like instrument that allows the doctor to view the inside of the anal canal. This procedure can help identify more serious conditions, such as hemorrhoids or anal cancer, which can sometimes cause similar symptoms to fissures.
3. Digital Rectal Exam (DRE): In some cases, the doctor may perform a digital rectal exam (DRE) to check for other conditions, such as muscle spasms or underlying rectal abnormalities that may contribute to the fissure.
4. Other Tests: If the fissure is associated with inflammatory bowel disease (IBD) or other systemic conditions, the doctor may recommend additional tests, such as a colonoscopy, to examine the gastrointestinal tract.

Treatment Options for Anal Fissures

The treatment of anal fissures depends on their severity and underlying causes. Most anal fissures can be treated conservatively with non-invasive measures. However, in severe cases, surgery or other medical interventions may be necessary. Treatment options include:

1. Dietary Changes: Increasing fiber intake and drinking plenty of water can help prevent constipation and soften stools, making them easier to pass. This reduces the strain on the anal region and helps prevent further injury to the skin.
2. Topical Medications: Over-the-counter creams or ointments containing hydrocortisone or other soothing ingredients can help reduce inflammation and promote healing. Some doctors may also prescribe medications that relax the anal sphincter muscle (such as nitroglycerin ointment) to reduce pain and spasm.
3. Warm Sitz Baths: Soaking in a warm sitz bath for 10–15 minutes a few times a day can help relieve pain, relax the anal sphincter, and promote healing. A sitz bath can also improve blood flow to the affected area.
4. Stool Softeners: If constipation is a contributing factor, stool softeners or mild laxatives may be prescribed to make bowel movements easier to pass and reduce strain.
5. Pain Relievers: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help alleviate discomfort associated with anal fissures.
6. Botox Injections: In more severe cases, Botox injections may be used to relax the anal sphincter muscle, allowing the fissure to heal. This is often a treatment option when conservative methods fail.
7. Surgical Treatment (Lateral Internal Sphincterotomy): If an anal fissure does not heal with conservative treatment, surgery may be required. A lateral internal sphincterotomy involves making a small incision in the anal sphincter muscle to relieve pressure and allow the fissure to heal. This surgery is typically safe and effective, with most patients recovering fully.
8. Addressing Underlying Conditions: If an anal fissure is caused by an underlying condition, such as inflammatory bowel disease, treating the condition itself may help prevent recurrent fissures.

Prevention of Anal Fissures

Preventing anal fissures often involves lifestyle and dietary changes aimed at reducing strain on the anal area. Some preventive measures include:

1. Maintaining a High-Fiber Diet: Eating plenty of fruits, vegetables, and whole grains can help prevent constipation and ensure soft, easy-to-pass stools.
2. Staying Hydrated: Drinking plenty of fluids throughout the day helps keep the stool soft and reduces the risk of constipation.
3. Avoiding Prolonged Sitting: Avoid sitting for extended periods, particularly on the toilet, as this can increase pressure on the anal area and lead to fissures.
4. Gentle Hygiene: Wipe gently after bowel movements and avoid using harsh toilet paper or scented wipes that can irritate the skin.

Conclusion

Anal fissures are a common condition that can cause significant discomfort, but they are usually treatable with conservative measures. For many people, making dietary changes, taking warm sitz baths, and using topical medications are sufficient to relieve symptoms and promote healing. However, for persistent or severe cases, medical interventions such as Botox injections or surgery may be required.

If you experience symptoms such as sharp pain during bowel movements, blood in your stool, or discomfort in the anal region, it's important to consult Dr Gaurav Sangam. Early diagnosis and treatment can help prevent complications and ensure that you receive the appropriate care to heal the fissure effectively.