What is anal fissure?
What exactly are anal fissures? How does a person get them and can they be avoided? Anal fissures can be painful, and some even bleed. Why anal fissures happen can be attributed to some of these causes:
- Anal fissures can occur when a person is constipated.
- These cuts and tears in your anal area can also happen when pressure is present within the said area.
- Anal fissures are also probable to occur when a person experiences bowel problems like diarrhea.
- If a person suffers from an inflamed anal area, like when a woman is pregnant or due to the ingestion of too much spicy food, even the softest of bowel movements can bring about these anal fissures.
- This problem can also come about as a result of other health issues like fever, abdominal pains, weight loss problems, tuberculosis and syphilis, to name but a few.
Symptoms of Anal Fissures
When you suspect that you may be suffering from anal fissures, keep an eye out for any of these possible symptoms that come with this problem:
- You might feel a burning pain or some sharp stinging sensations around your anal area when you move your bowels or after doing so.
- If you see blood spots on the toilet paper you use after you discharge, that can also indicate a possible anal fissure.
- If you find that your discharges have a queer smell or that your anal areas itch after discharging, you might also be suffering from an anal fissure.
- This condition is more common in women.
- It is mostly seen between 30-50yrs of age.
- It occurs sometimes in children and may cause acquired mega colon. But it is rare in the aged due to muscular atony.
- Constipated hard stool while passes through the anal canal in patients where there is spasm of internal sphincter and hypertrophied anal papilla an acute tear of the anal canal will occur.
- This acute fissure will cause spasm, pain of the defecation and passage of bright streaks of blood along with the stool or will be seen in the tissue paper.
- If the acute fissure fails to heal, it will gradually develop into a deep undermined ulcer. This is termed ‘chronic fissure-in-ano’.
- A typical chronic anal fissure will have in its upper end a hypertrophied anal papilla. At its lower end a tag of hypertrophic skin, which is called a sentinel pile and canoe-shaped ulcer in between the upper and lower ends.
- Pain and bleeding are two main symptoms of this condition. Pain starting with and following defecation (usually following an hour or more) has been variously described as sharp, biting, burning etc.
- Pain is sometimes intolerable and pain is the main symptom in anal fissure.
- Bleeding if anal fissure in variable, but usually occurs as streaks on the outside of the stool or spots noted on toilet tissue.
- Slight discharge may accompany a fully established chronic fissure. Pruritis ani or anal itching may be another symptom.
- On examination:
- A tightly closed puckered anus is almost certain of this condition. Acute fissure is not palpable. But in chronic fissure, the characteristic crater of the vertical fissure may be felt.
Causes of Anal Fissures
- Constipation- this has been the most common etiological factor.
- Spasm of the internal sphincter has also been incriminated to cause fissure-in-ano.
- When too much skin has been removed during operation for hemorrhoids, anal stenosis may result in which anal fissure may develop when hard motion passes through such stricture.
Secondary causes of anal fissure starts proximal at the dentate line. So whole of the anal fissure lies in the sensitive skin of the anal canal and that is why pain is the most prominent symptom.
Preventing and Treating Anal Cuts
While most of these anal fissures heal all by themselves over a period of time, sometimes you will need to do something to help speed up the process or heal those tears that seem to be lingering. Here are a few suggestions you might want to try:
- Try doing what is called a Sitz bath. This is simply the soaking of your backside or anal area in a tub of warm water for a short period of time.
- You can try using natural stool softeners like papaya to make bowel movements easier and for these tears to heal faster.
- For treating the burning and itching sensations, you might want to try aloe vera gel or tea bags that have been dipped in cold water for a cooling and soothing effect.
- Try applying a paste that is made of clarified butter and some turmeric powder. This will help speed up the curing process of the tear while keeping it away from infection.
- Prevention is better than cure so try to eat a high-fiber diet and a low-carbohydrate one to help avoid these cuts in the future. Try to avoid eating sharp foods as well like corn, tortilla chips, and peanuts.
A. Acute ulcers with short history usually heal with conservative treatment. Conservative treatment include
- Oral pain medication, which may be taken before any anticipated bowel movement.
- Stool softener may be used to make the stool enough to be passed without anal spasm. Weak bulk laxative or cathartics is best in this condition.
- Soothing ointments may be applied with doubtful efficacy. 5% xylocaine ointment may be introduced into the anal canal with fine nozzle.
- Self dilatation in highly important as this will relax the anal musculature and resolve with healing of the fissures. After 5min of application of 5% xylocaine ointment a small anal dilator should be passed into the anal canal. Anal dilators are commonly made in three sizes. Gradual dilatation of the anal canal is advised by using large dilators.
- Injection of long acting anesthetic solution promotes little relief and has significant complications.
B. Chronic ulcers- though in these cases conservative treatment may be tried, yet in majority of cases this treatment fails and surgical management should be called for. Surgical methods for Anal fissures. . .
- Anal dilatation- lord’s procedure of anal dilatation is the simplest method to dilate the sphincter of the anal canal. When the chronic fissure is with excessive fibrosis and skin tag, there is every chance that anal dilatation will be a failure. In these cases operation is justified.
- Posterior sphicterotomy and fissurectomy- transverse fibers are divided and the floor of the fissure is made smooth. If the ulcer is deep with fibrotic edges the ulcer should is excised. Only disadvantage of this operation is long recovery phase of 7-10days and in occasional cases there may be persistent mucous discharge.
- Lateral anal sphincterotomy- in this operation the internal sphincter is divided away from the fissure either on the right or left lateral position. This operative is more appropriate for early cases.
- Excision of anal ulcer- along with skin graft to limit the convalescent period has not been successful.