An anal fissure is a tear in the lining of the anus that causes pain during bowel movements. It may be noticed by bright red anal bleeding on toilet paper, sometimes in the toilet. If acute they may cause pain after defecation but with chronic fissures pain intensity is often less.
Most anal fissures are caused by stretching of the anal mucosa beyond its capability. They are caused by injury (trauma) to the anal canal.
Injury can happen if:
You pass a large stool that stretches the anal canal.
You are constipated and try to pass a hard stool.
You have repeated diarrhea.
Other common causes of anal fissures include:
childbirth trauma in women
Poor toileting in young children
Pain: It generally causes a sharp, stinging, or burning pain during defecation.
Rectal bleeding: They often bleed lightly or cause a yellowish discharge. You may see a small spot of bright red blood on toilet tissue or a few drops in the toilet bowl. The blood is separate from the stool.
Sometimes an anal fissure may be a painless wound that won't heal and that bleeds intermittently but causes no other symptoms.
Avoid straining when defecating. This includes treating and preventing constipation by eating food rich in dietary fiber, drinking enough water, occasional use of a stool softener, and avoiding constipating agents. Similarly, prompt treatment of diarrhea may reduce anal strain.
Careful anal hygiene after defecation, including using soft toilet paper and/or cleaning with water.
In infants, frequent diaper change can prevent anal fissure. Adequate fluid intake is recommended to avoid constipation. In infants, once an anal fissure has occurred, addressing underlying causes is usually enough to ensure healing.
Non-surgical treatments are recommended initially for acute and chronic anal fissures.
Tropical ointment application
Sitz bath 2-3times daily
Increase fiber intake in diet
Stool softeners or laxatives
Medication: Local application of medications to relax the sphincter muscle, thus allowing the healing to proceed.
Surgery: It is generally reserved for people with anal fissure who have tried medical therapy and have not healed. Surgical procedure like Lateral internal sphincterotomy, etc. can be done.