Anal fissure

Anal fissure

Definition  :

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. An anal fissure usually heals on its own within four to six weeks. If it doesn't, medical treatment or surgery usually can relieve discomfort.

Symptoms:

Signs and symptoms of an anal fissure include:

• Pain, sometimes severe, during bowel movements
• Pain after bowel movements that can last up to several hours
• Bright red blood on the stool or toilet paper after a bowel movement
• Itching or irritation around the anus
• A visible crack in the skin around the anus
• A small lump or skin tag on the skin near the anal fissure

When to see a doctor
See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.

Causes:

Common causes of anal fissure include:

• Passing large or hard stools
• Constipation and straining during bowel movements
• Chronic diarrhea
• Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease
• Childbirth

Less common causes of anal fissures include:

• Anal cancer
• HIV
• Tuberculosis
• Syphilis
• Herpes

Complications:

 Complications of anal fissure can include:

• Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment.
  
• Recurrence. Once you've experienced an anal fissure, you are prone to having another one.
  
• A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.

Treatments and drugs:


Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.
If your symptoms persist, you'll likely need further treatment.

Nonsurgical treatments
Your doctor may recommend:

• Externally applied nitrogylcerin, to help increase blood flow to the fissure and promote healing, and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache.
• Steroid creams, to help relieve discomfort.
  
• Botulin toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms.
  
• Blood pressure medications, which can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin in not effective or causes significant side effects.

Surgery
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Surgery usually involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Surgery has a small risk of causing incontinence.