Anal Fissures – Symptoms, Causes & Treatment

An anal fissure is a painful condition in which there is a tear or cut in the thin and delicate tissue that lines the anus. In some cases, the tear may even expose the anal sphincter, which is the muscle around the anus. This can cause the muscle to experience spasms that can further widen the fissure, causing severe pain and slowing down healing. Passage of stools can also cause pain and may delay healing of the fissures. If the condition persists for more than 6 weeks or occurs frequently, it is regarded as chronic.

Symptoms

Symptoms of anal fissures may include:

• Sharp pain during bowel movements
• Lingering pain after passage of stools
• Burning or itchiness of the anal region
• Presence of blood in stools
• A visible tear or crack in the skin
• Presence of a small lump or skin tag near the fissure

Causes

The most common causes of anal fissures include chronic constipation or passage of hard stools and frequent diarrhea. Anal fissures can also be caused by:

• Straining to pass stools or during childbirth
• Reduced blood circulation to the anorectal region
• Tightness or spastic anal sphincter muscles
• Presence of conditions like inflammatory bowel disease

Certain factors may increase the risk of anal fissures, such as indulging in anal intercourse and age as it is more common in infancy and older adults.

Although rare, anal fissures may also be caused by other underlying conditions such as anal cancer, tuberculosis, HIV infection, herpes, or syphilis.

Tests

In most cases, your doctor would be able to diagnose an anal fissure through the reported symptoms and an examination of the anal region. However, to make a more accurate diagnosis and identify possible underlying causes, certain tests may be recommended.

• Anoscopy – A thin tube, called an anoscope, is inserted into the rectum so that the tear can be inspected closely.
• Flexible sigmoidoscopy – A thin flexible tube that has a tiny camera is inserted into the colon to look for any blockage or abnormalities in the lower part of the colon. This is typically used for adults under 50 with no known risk factors for colon cancer or intestinal diseases.
• Colonoscopy – Similar to a flexible sigmoidoscopy, the procedure involves the insertion of a thin flexible tube with a tiny camera into the rectum. However, in this procedure the entire colon is examined and it is used for adults over 50 and for anyone at risk of colon cancer or other intestinal diseases.

Treatment

Anal fissures can heal without medical intervention within a few weeks, if you increase fiber and fluid intake to ease bowel movements. Warm water soaks can also help relax the sphincter and encourage healing. However, such measures may not be adequate due to severe pain or persistence of symptoms. In such cases, medical treatments can include both nonsurgical and surgical approaches.

Nonsurgical treatment

• Ointments or creams containing nitroglycerin that are applied externally encourage blood flow and promote healing of the fissure. This can also help relax the sphincter muscle, providing quick relief.
• Anesthetic creams can also be prescribed to provide relief from painful symptoms.
• Botox injections may be administered to the region to paralyze the anal sphincter muscle, which will prevent spasms and facilitate healing of the fissure.
• Blood pressure medications may be used to relax the anal sphincter to relieve symptoms and facilitate healing. This can include oral or topical treatments and they are used when nitroglycerin is ineffective.

Surgical Treatment

Patients who experience severe symptoms or suffer from chronic anal fissures will not respond to nonsurgical treatments alone. In such cases, doctors will recommend surgery. Surgical treatment of anal fissures involves a procedure to excise a small part of the anal sphincter muscle and is called lateral internal sphincterotomy (LIS). The procedure is performed under general anesthesia and helps reduce spasms of the anal sphincter muscles, relieving pain and facilitating healing.

Surgical treatment of anal fissures is regarded as the most effective treatment for chronic fissures.

Why Aware Gleneagles Global Hospital for Piles Treatment?

Aware Gleneagles Global Hospital is the best choice if you’re looking for an effective treatment for anal fissures, especially when severe or chronic. With highly skilled colorectal surgeons or proctologists and state-of-the-art medical technology, you can expect your anal fissure treatment to be safe and successful.

Dr Sivananda Reddy

Consultant – Medical Gastroenterology & hepatology