Anal Fissure

What should you know about Anal Fissure?

Anal fissure is a tear or ulcerin the lining of the anal canal. It is a common condition in all ages with a peak occurrence in people aged 15 – 40 years and all genders. These fissures may happen in different parts of anus which include the anterior (front) and posterior (back) areas. The posterior fissures are very common and occur due to trauma during the bowel movements, while anterior fissures are related to inflammatory bowel disease.

Know about the structure of Anal Canal

To fully understand how anal fissures occur, it is necessary to know about the structure of the anal canal.

• The anal canal is the terminal part of your digestive tract, and it conveys excretory materials from the rectum to the anus.
• The anal canal has two anal sphincters called internal anal sphincter and external anal sphincter which control and co-ordinate the process of defecation.
• The anal canal is lined by a musical lining which plays a vital role in defence against micro-organisms and foreign bodies entering through the anal opening.

Anal fissures usually occur in the posterior midline of anal canal, where your skin gets thinner and highly prone to damage. The pressure exerted during the bowel movement may lead to tiny tears in this area, leading to anal fissures.

Types of Anal fissures

• Acute: If the symptoms are less than 6 weeks
• Chronic: If the symptoms have persisted more than 6 weeks or longer
• Primary: There are no underlying causes
• Secondary: Underlying diseases such as inflammatory bowel disease, colitis, sexually transmitted infections such as HIV, or colorectal cancer.

Common Symptoms

The symptoms may differ from one person to the other though there are common signs to consider. One of the symptoms is extreme pain during the defecation. This pain can range from mild discomfort to extremely sharp painwhich may last for many hours after passing stools. Another symptom is bleeding at the time of bowel movements, which can be bright red blood in the toilet bowl or on toilet paper.

Other than excessive bleeding and pain, individuals withanal fissures might experience burning and itching around the anus. This may cause furtherdiscomfort while sitting because of the pressure on the affected area, thus exacerbating the pain.This can be a cause of further embarrassment in day-to-day activities.

Identify Signs of Anal Fissures

• Painful defecation
• Burning or sharp pain during the bowel movement
• Visible cut or tear in your skin around the anus
• Blood in stool which can be bright red blood in the toilet bowl or on toilet paper
• Constant irritation or itching around your anus
• Tenderness or soreness around the anus for hours after stools
• Hard stools and straining at stools.

Detecting the signs of anal fissures is necessary to seek appropriate medical attention. Sharp cutting pain is the most common symptom for which patients seek immediate attention. This is the common presentation in an acute case. One of the visible signs is presence of cuts or tears in your skin around the anus. These can be in the form of small, open wounds or red lines. Inflammation and swelling around the anus are common signs of anal fissures which appear red and feel tender to your touch.

There are cases when individuals identify the presence of lumps or skin tags around the anus. These usually occur due tothe healing process and can detect an anal fissure has occurred. Make sure you do not ignore these signs, as they indicate a serious underlying condition.

Causes

Different factors can be the reason for developing anal fissures.

• One of the main causes is straining and constipation during bowel movement. When stool is challenging to pass and complex, it can cause excess pressure on the anus, leading to tears in your skin. This is the common cause of chronic anal fissures.
• Similarly, diarrhoea and frequent bowel movements might lead to anal fissures, as constant inflammation and irritation may weaken your skin around the anus.
• Having any kind of injury or trauma to anal area such as inserting foreign objects or wiping can be the reason for anal fissures. Also, any previous anal surgeries.
• Use of commode toilets rather than the squatting of primitive societies has been identified as the cause of resting sphincter pressure.
• Decrease in the mucosal blood supply to the posterior commissure of the anal canal.
• Low-fibre diets those deficient of green leafy vegetables and fruits.

Besides, individuals who suffer from inflammatory bowel disease like Crohn’s disease or ulcerative Colitis are at greater risk of suffering from anal fissures due to severe inflammation in your digestive tract.

Risk Factors

Though anyone may develop anal fissures, certain factors predispose to the chances of suffering from this condition.

• Age and gender have a crucial role, with women and old adults highly prone to developing anal fissures.

• Pregnancy and childbirth may enhance the risk due to the strain placed on your pelvic area during this process.

• Certain medical conditions like AIDS/HIV or inflammatory bowel disease may make individuals highly susceptible to anal fissures.

• Though some medications like those used for treating high pressure or depression might contribute to diarrhoea or constipation. This can increase the risk of developing anal fissures.

How Anal Fissure is diagnosed?

A thorough physical examination of the anus and the rectum is conducted to confirm the diagnosis of anal fissures and to rule out other similar conditions such as haemorrhoids and anal abscess. The healthcare provider will be inspecting the area for any visible cuts or tears. They may conduct a digital rectal examination, where gloved finger gets inserted into the rectum to detect abnormalities.

There are cases when further medical tests and procedures may be essential to identify the diagnosis or rule out other conditions. These include an Anoscopy, where a small tube with the light gets inserted into the anus to examine anal canal, proctoscopy/colonoscopy/sigmoidoscopy to assess the entire colon and rectum.

Medical Treatments

Different medical treatments are available for anal fissures, based on the severity and duration of symptoms.

• Topical ointments and medications are usually prescribed for wound healing and pain relief. These include numbing agents, such as lidocaine, glycerine nitrate or medicines to relax muscles around the anus.
• In some cases, Botox injections may be recommended to relax sphincter muscles and decrease pressure on anal fissure. This may help to lessen the pain and stiffness of the sphincter muscles.
• Laxatives are prescribed for constipation.
• There are severe cases when surgery may be needed to repair anal fissure and avoid recurrence. In these case lateral sphincterotomy is done which is most effective in chronic cases with good success rates. Advancement anal flaps are performed in case of anal fissures caused by pregnancy, or an injury to anal canal where healthy tissue from another part of your body is used to repair anal fissure.

Non-Surgical Treatments

• Non-surgical treatments are generally the first line of treatment for dealing with anal fissures. Sitz baths, where the affected area is soaked in warm water to relieve pain and sterilise the wound. Stool softeners and laxatives may be prescribed to avoid constipation and lessen strain during bowel movements.

• Fibre supplements, such as methylcellulose or psyllium husk are recommended in cases of diarrheal diseases such as Crohn’s disease or colitis. These supplements contain insoluble plant fibres which add bulk to the faecal matter and slows down the bowel movements.

• Osmotic agents such as milk of magnesia, Miralax are recommended to relieve constipation. However, you should only use stimulants if your constipation is severe or other treatments have not worked.

• It is of utmost importance to consult a gastroenterologist before you start a dietary supplementation as the needs and requirements vary for every individual patient and sometimes contraindicated in a given patient.

Dietary Recommendations

Dietary changes can play a major role in relieving discomfort and facilitate anal fissure recovery. Taking high and soluble fibre diet is suggested to promote regular bowel movements and avoid constipation. Soluble Fibre-rich foods include vegetables, fruits, whole grains, and legumes. It is necessary to increase the intake of fibre as it softens the stools, improves microbiome and gut mobility.

Drinking sufficient amount of water is necessary to maintain proper hydration and stool softening. Adequate intake of water can prevent constipation and make bowel movements comfortable. On the other hand, do not eat acidic and spicy foods as they may cause irritation to the digestive system and worsen your symptoms.

Lifestyle Changes

Other than medical and non-surgical treatments, making some changes in your lifestyle can manage anal fissures in an effective way. Routine exercise and physical activity can promote healthy bowel movements and avoid constipation. Try to engage in various activities that get your body moving, such as swimming or walking.

Proper hygiene and anal area cleaning are necessary to avoid further infection and irritation. Wipe gently by using soft toilet paper or wipes to keep the area clean and dry without causing any damage. Do not take certain foods and drinks that can cause irritation to the digestive system, such as alcohol or spicy foods to aid in managing anal fissures.

Prevent Anal Fissures from Recurrence

Anal fissures are known to recur and hence it is essential tomake changesfor the long term. Maintaining a healthy diet and proper lifestyle can prevent diarrhoea and constipation as significant contributors to anal fissures. Proper hydration, high-fibre diet and daily exercise need to be incorporated into your daily routine.

Treating various medical conditions like HIV/AIDS or inflammatory bowel disease is necessary to prevent recurrent anal fissures. Routine check-ups with the healthcare provider may help to evaluate any changes or developments in the condition and ensure getting appropriate treatment.

Thus, anal fissures might leave a considerable impact on routine life, causing discomfort and pain. Make sure you are aware of the symptoms, know the causes, and seek medical attention for managing this condition effectively. Medical treatments, non-surgical options, dietary recommendations, natural remedies and lifestyle changes play a crucial role in alleviating the symptoms and preventing further recurrence. Talk to a healthcare provider who will always assess persistent symptoms to ensure proper diagnosis and treatment.

Natural Remedies

Apart from medical treatments and lifestyle changes, various natural remedies can help to lessen the symptoms of anal fissures. Aloe vera, popular for its soothing properties, may be applied topically on the affected area to lessen inflammation and pain. Coconut oil, with its antimicrobial and moisturizing properties, can offer relief when it is applied gently to anal fissure.Witch hazel, a natural astringent, may be used to cleanse anal area and lessen burning and itching.

Though these natural remedies may offer temporary relief, they should not replace medical treatments or professional advice. Anal fissures as a primary disease or secondary to any underlying diseases such as irritable bowel disease or HIV can be identified only by a professional such as a gastroenterologist. Hence seek medical advice and treatment to manage the condition effectively.