Anal Fissure

What is an Anal Fissure?


An anal fissure is a cut or tear in the anus, that extends upwards into the anal canal. They are a common condition and responsible for a substantial amount of visits to a colon and rectal (colorectal) surgeon. 


They affect both men and women equally, as well as the young and the old. Fissures usually cause severe pain during bowel movements and is the most common cause of rectal bleeding in infancy.

Achalasia

What are the signs and symptoms?


The primary symptom of anal fissures is pain during and following bowel movements. Other symptoms may include bleeding, itching, and a malodorous discharge.


What causes anal fissures?


Anal fissures are caused by trauma to the anus and anal canal. The cause of the trauma usually is a bowel movement, and many people can remember the exact bowel movement during which their pain began. The fissure may be caused by a hard stool or repeated episodes of diarrhea.


Where do anal fissures occur?


Anal fissures occur in the specialized tissue that lines the anus and anal canal, called anoderm. Unlike skin, anoderm has no hairs, sweat glands, or sebaceous (oil) glands and contains a larger number of sensory nerves, and this is why fissures are so painful.


How are anal fissures diagnosed?


Anal fissures are diagnosed and evaluated by visual inspection of the anus and anal canal.


What home remedies help relieve pain and treat anal fissures?


Anal fissures are initially treated conservatively with home remedies and OTC products that include adding bulk to the stool, softening the stool, consuming a high fiber diet, and utilizing sitz baths.


What prescription drugs treat anal fissures?


Prescription drugs used to treat anal fissures are ointments containing anesthetics, steroids, nitroglycerin, and calcium channel blocking drugs (CCBs).


Does surgery cure anal fissures?


Surgery by lateral sphincterotomy is the gold standard for curing anal fissures. Because of complications, however, it is reserved for patients who are intolerant of non-surgical treatments or in whom non-surgical treatments have proven to be ineffective.


What exams, procedures, and tests diagnose anal fissures?


A careful history usually suggests that an anal fissure is present, and gentle inspection of the anus can confirm the presence of a fissure. If gentle eversion (pulling apart) the edges of the anus by separating the buttocks does not reveal a fissure, a more vigorous examination following the application of a topical anesthetic to the anus and anal canal may be necessary. A cotton-tipped swab may be inserted into the anus to gently localize the source of the pain.


An acute anal fissure looks like a linear tear. A chronic anal fissure frequently is associated with a triad of findings that includes a tag of skin at the edge of the anus (sentinel pile), thickened edges of the fissure with muscle fibers of the internal sphincter visible at the base of the fissure, and an enlarged anal papilla at the upper end of the fissure in the anal canal.