Anal fissure

Overview

An anal fissure is a small tear in the thin layer lining the anal canal. It is a common cause of anal pain and is often confused with hemorrhoids, but it is a different condition.

• Acute fissure — recent; often heals within a few weeks.
• Chronic fissure — lasts more than 6–8 weeks.

Symptoms

• sharp, cutting pain during bowel movements, which may continue for minutes or hours afterward
• bright red blood on the toilet paper or on the stool
• burning or itching
• in chronic fissures, a small skin tag at the outer end of the tear

Persistent bleeding should not be attributed to the fissure alone without an examination.

Causes

• hard stools and straining (constipation)
• frequent diarrhea
• childbirth

Spasm of the internal sphincter muscle reduces blood flow to the area and impedes healing — this creates a vicious cycle of pain and spasm.

Multiple fissures or fissures in atypical locations require evaluation for other causes, such as Crohn's disease.

Diagnosis

Often a conversation and a careful inspection of the area are enough. When the pain is very severe, the finger examination or anoscopy may be postponed. Colonoscopy is not needed for every fissure — it is recommended according to age, symptoms and suspicion of another disease.

Treatment

First measures

• Soft stools: add fiber gradually, drink enough fluids; the doctor may recommend a stool softener or a mild laxative.
• Warm sitz baths (10–15 minutes, several times a day) soothe the spasm.
• Do not sit on the toilet for long and avoid straining.

Topical medicines

For fissures that do not heal, ointments that relax the sphincter are used, such as diltiazem, nifedipine or nitroglycerin, by prescription. Nitroglycerin often causes headache.

Chronic fissure

• Botulinum toxin injection into the sphincter can help relaxation and healing.
• Lateral internal sphincterotomy — a minor surgical procedure, very effective in selected cases. Before the decision, the small risk of a change in control of gas or stool is discussed.

Diet

There is no reason to automatically stop bananas, yogurt or cottage cheese. Choose foods with fiber and avoid only those that, in your experience, cause you constipation.