An anal fissure is a small cut or tear in the skin lining the anus. Childbirth, straining during bowel movements, or bouts of constipation or diarrhea can all tear the anal lining. Anal fissures are usually not a cause for concern and most heal without any medical treatment. However, those resistant to treatment may require surgery.
With an anal fissure, you may experience one or more of the following symptoms:
- a visual tear on the anus
- a skin tag (small lump of skin) next to the anal fissure
- extreme pain in the anal area during bowel movements
- streaks of blood on stools or on tissue paper after wiping
- burning or itching in the anal area
The skin around the anus can be torn when passing large or hard stools. Chronic constipation or frequent diarrhea can also tear the skin. Other causes:
Crohn’s disease or another irritable bowel disease
straining during childbirth
decreased blood flow in the anorectal area due to old age
overly tight or spastic anal sphincter muscles
A doctor can usually diagnose an anal fissure with just a visual exam. However there may be a need to insert an endoscope (a small lighted tube) or anoscope into your rectum to make it easier to see the tear.
Most anal fissures heal with just home care treatments like adding fiber supplements to your diet or using over-the-counter stool softeners. Warm baths can relax the anal muscles, relieve irritation, and increase blood flow to the area. There are also over-the-counter ointments, such as Anusol-HC, that can soothe some of the discomfort.
Topical pain relievers, such as Lidocaine, applied to the anus can help relieve the pain. Your doctor can also suggest a brand of calcium channel blocker ointment that can relax the sphincter muscles and allow the anal fissure to heal.A topical nitroglycerin ointment applied to the anus widens the blood vessels in the anus, encouraging blood flow to the area, will also promote healing.
Another treatment is Botox injections into the anal sphincter. This will prevent spasms in the anus by temporarily paralyzing the muscle. The purpose is to allow the anal fissure to heal while preventing new fissures from forming.
If your anal fissure fails to respond to other treatments your doctor may recommend an anal sphincterotomy. This is a surgical procedure where a small incision is made in the anal sphincter to relax the muscle, which allows the anal fissure to heal.
For unknown reasons, anal fissures are common during infancy. They occur in approximately 80 percent of babies during the first year of life. Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. During and after childbirth, women are at risk because of the straining during delivery.
If you have an inflammatory bowel disease, such as Crohn’s disease, you have a higher risk of developing anal fissures. This is because the inflammation in the intestinal lining makes the tissue more prone to tearing. You are at risk of developing anal fissures if you experience frequent constipation where you have to strain to pass stools.
Although anal fissures cannot always be prevented, you can reduce your risk of getting one with the following guidelines:
- to prevent anal fissures in infants, change diapers frequently
- keep the anal area dry
- cleanse the anal area gently
- avoid constipation by drinking plenty of fluids, eating plenty of fiber, and exercising regularly
- treat diarrhea immediately