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Anal Fissures
What Is an Anal Fissure?
An anal fissure is a split or tear in the lining of the anal canal (rectal
opening).
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When Does a Fissure Occur?
A fissure most commonly occurs after an episode of constipation, but
it can happen after an attack of diarrhea. A fissure begins on the surface
and may heal rapidly on its own. Sometimes fissures may deepen to reach
the underlying sphincter muscle (the muscle around the anal canal). It
is not completely understood why some fissures heal and others do not.
One major factor is persistent constipation or diarrhea, which can prevent
healing. In addition, each time stool passes, the muscle goes into spasm
and cramps, tightening the anal canal. If the sphincter muscle does not
relax and the anal canal remains too tight, the fissure opens again with
each bowel movement. Rarely, a fissure can be caused by Crohn's disease
or an infection. Treatment for the underlying disease usually relieves
the fissure. Fissures very rarely become infected and they do not become
cancerous.
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What Are the Symptoms?
Symptoms of a fissure can include:
- Rectal pain. People often describe it as burning or tearing pain
with a bowel movement. The pain may last for minutes or persist for
hours after a bowel movement. The pain that lasts after a bowel movement
is caused by the spasm in the sphincter muscle. Some people avoid having
a bowel movement because of the pain.
- Rectal bleeding. It is usually small amounts of bright, red blood
that can be seen on the toilet paper or in the toilet water.
- Swelling. Swelling at the outer end of the fissure can result in
a skin tag. It may be noticed when cleaning the rectal area.
- Itching. Discharge may result as the fissure alternately heals and
reopens, causing itching.
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How Is a Fissure Treated?
Most superficial fissures heal without treatment, but some become chronic
and cause ongoing discomfort. The first step is to correct the constipation
or diarrhea and treat any underlying disease. A high-fiber diet or dietary
bulk agent with plenty of fluids is recommended. A topical anesthetic
ointment may help relieve the pain. The spasm may also be relieved by
sitting in a warm bath several times a day. These measures usually result
in healing. If they do not or the symptoms return, surgery may be required.
This will be discussed with you by your doctor.
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What Can I do to Prevent Another Fissure?
- If constipation is a problem, eat foods high in fiber. Drink 8-10
glasses of fluid that does not contain caffeine or alcohol. Your doctor
may recommend a commercially available natural fiber product to increase
your fiber intake.
- If symptoms do recur, take warm baths. This will help to reduce the
spasm and lessen the pain.
- If your doctor recommends an ointment, apply it directly to the painful
area.
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