Anal fissure is a painful tear in the lining of the anal canal, which can result from constipation accompanied by dry or hard stools and can also be caused by frequent diarrhea or irritation of the anal canal and rectum.
Risk factors for developing an anal fissure:
Constipation, straining during bowel movements, previous surgery on the anal canal that could cause scarring and reduced tissue elasticity, chronic diarrhea.
Symptoms:
The symptoms of an anal fissure are similar to those of more severe conditions. Therefore, it is essential to seek medical attention if experiencing the following symptoms:
• Pain during and after bowel movements.
• Burning sensation during bowel movements.
• Bleeding with bowel movements.
• Bright red blood on toilet paper or in the stool.
• Itching around the anal canal.
• A small amount of mucus in the stool.
Diagnosis:
A physical examination that includes an inspection of the anal canal is the initial diagnostic step. If the fissure has been present for three months or more, additional changes may be observed. These changes can include skin tags or thickening of the skin, granulation tissue, or whitening of the area around the fissure due to the formation of scar tissue.
In some cases, additional tests may be performed if there are multiple fissures or if a fissure is located in an unusual area to rule out other causes.
Treatment:
The treatment goal is to heal the fissure and prevent future problems around the anal canal. About half of the fissures can heal on their own or with self-care. A new fissure usually heals relatively easily compared to those present for more than three months.
Conservative treatments for an anal fissure include:
• Avoiding hard or dry stools and having regular bowel movements.
• Drinking at least eight cups of water per day.
• Consuming a high-fiber diet.
• Using stool softeners or laxatives as prescribed by a doctor.
• Regular physical activity.
• Applying ointments or creams to the anal canal, as prescribed by a doctor.
• Sitz baths, especially after bowel movements, to reduce pain and increase blood flow to the area.
• Botox injection, which temporarily weakens the anal sphincter muscle and allows the fissure to heal.
It is generally recommended to try conservative treatment for about a month, and if there is no improvement, surgical treatment can be considered.
Surgical treatments may be necessary in specific cases, such as fissures that do not heal or recur, scar tissue, or muscle spasm of the anal sphincter that contracts and prevents the fissure from healing. One common surgical procedure is called sphincterotomy, in which the doctor performs a small cut and divides certain fibers of the anal sphincter to reduce the strength of the muscle contractions during bowel movements, allowing the fissure to heal.
The surgical procedure usually lasts a few minutes and is performed under regional anesthesia (spinal anesthesia). The recovery may involve some discomfort for several days to weeks, gradually decreasing over time. It is essential to follow post-operative instructions to prevent the recurrence of fissures.
Prevention:
Most anal fissures are caused by hard and dry stools characteristic of constipation. There are several recommendations to prevent constipation:
• Drink at least eight cups of water per day.
• Engage in regular physical activity.
• Eat a high-fiber diet, including fruits, vegetables, legumes, and whole grains.
• Avoid straining during bowel movements.
Wishing you a full recovery and fast healing!