What Is Anal Fissure And What Are Its Symptoms?

Have you experienced pain during bowel movements? Or perhaps noticed red blood in your stool? Maybe some cracks around your anal sphincter? One of the problems that can cause the above symptoms with/ without other conditions is a fissure, also known as anal fissure. A small tear or a cut in the moist tissue (mucosa) lining the anus is called an anal fissure. The crack can cause pain and some bleeding during or after bowel movements. If the fissure is deep, it could expose the muscle tissue underneath as well.

Symptoms Of Anal Fissure Includes

• Pain – from mild to severe while passing stool
• Pain – post bowel movements, may last up to several hours
• Bright red blood spots on stool/ after using toilet paper
• Visible tear in the skin around the anus
• Small lump near the anal fissure
• Spasming anal sphincter muscles

What Causes Anal Fissure?

Most of the time, anal fissures are caused due to trauma/ injury stretching your anal canal such as passing hard and/ or large stools. Chronic constipation or frequent diarrhoea can also cause tearing around the anus. Some other common causes are:

• Strain caused during childbirth
• Inflammatory Bowel Disease (ongoing inflammation of all or some parts of the digestive tract)
• Explosive diarrhoea
• Anal sexual intercourse

How Serious Is Anal Fissure?

In most cases, anal fissure is not a serious or dangerous condition. While anal fissures can affect people of all age groups regardless of gender, infants and young children are most commonly affected. This is because constipation is a common issue in this age group.

In some cases, an anal fissure may require medication; and in extreme cases, surgery.

Most of the times, an anal fissure will heal within four to six weeks by itself. However, certain factors may prevent healing such as continued symptoms, too much pressure, spasming anal sphincter due to the pain caused by fissure and poor blood supply to the anus.

People suffering from certain medical conditions such as anal cancer, Leukaemia, STDs/HIVs, etc. may also suffer from anal fissures. Anal fissures that do not heal for more than six weeks or keep recurring are considered chronic and may require medical intervention as well as looking deeper into the actual cause behind fissure.

Anal Fissure Treatment Avenues

Here are some treatment methods that are used to find relief from anal fissures:

• External Application (Please ask for medical advice from a medical practitioner before use:
  • Topical anaesthetic creams: These can assist in pain relief. 
  • Botulinum toxin type A (Botox) injection: It is used to paralyze the anal sphincter muscle and help relax spasms
  • Blood pressure medications: These can help relax the anal sphincter

• Drinking fluids: Increasing water consumption can help soften stools and stimulate bowel movements by relieving constipation. You can also include fruits and vegetables with high water content such as broccoli, cabbage, cucumber, celery, lettuce, strawberries, watermelon, spinach etc.

• Fibrous diet: Appropriate amount of fibre is necessary for healthy bowel movements. It prevents constipation and diarrhoea. The US Food & Drug Administration recommends daily value for dietary fibre at 28 g based on a 2000 calorie diet. You can include high-fibre foods in your daily diet such as beans, lentils, chickpeas, artichoke, pumpkin seeds, soybeans, avocado, high-fibre cereal etc.

• Over The Counter (OTC) stool softeners: Different from laxatives, these are considered safe with few to no side-effects. These pills/ capsules help pull more water into our digestive tract to help soften stools. Please get a doctor’s recommendation for which OTC stool softener to use.

• Keeping yourself clean: Anal fissures will not heal if the area remains uncleaned post bowel movements. It is understandable that wiping post bowel movements can be painful in case of anal fissure. You can use a bidet or hand shower for deep cleaning. Please ensure that the nozzle pressure is gentle or else it may exacerbate the issue. Flannel washcloths and fragrance-free wet wipes can be alternatives to toilet paper which is usually rough.

• Sitz baths: This refers to sitting in a few inches of warm water for not more than 15 minutes with the anal fissure immersed inside the water. This will promote cleanliness and help find pain relief.

Lastly, if acute anal fissure turns into a chronic anal fissure, or if the symptoms are very severe, the doctor may recommend surgery to treat anal fissure. A procedure called lateral internal sphincterotomy is performed where a small portion of the anal sphincter is cut to reduce spasm, relieve pain and promote healing.