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Overview

Anal Fissure - Symptom, Treatment And Causes

What is Anal Fissure?

Anal fissure occurs because of a tear or cut in the anus, that extends up into the anal canal. Anal fissures are a common condition that happens with many people across the globe and are responsible for 6-15 patient percent visits to a colorectal surgeon.

Anal fissure can happen to anyone. Both men and women, young and old are affected with this malady. Fissure in the anal tract causes severe pain during defecation and bowel movement. In fact fissure in the anus, is the most common cause of rectal bleeding during childhood and infancy.Anal fissures typically happens in the specialized tissue that lines the anal canal and anus, known as anoderm. Unlike skin, anoderm do not have sweat glands, hairs or sebaceous glands. But it has a plethora of sensory nerves that can even sense light touch and pain. This abundance of nerves in the anoderm tissue is what makes anal fissures so painful. This most sensitive anoderm moves up for the entire length of the anal canal till it ends and meets the demarcating line where the rectum starts, which is known as the dentate line.

Causes :

Anal fissures are caused owing to trauma in the anal canal or in the anus. The most common cause for this trauma is bowel movement. So anal fissures can always be caused by repeated episodes or diarrhea or hard stool (constipation). Many a time insertion of an enema tip, rectal thermometer, ultrasound probe (for examination of the prostate), and endoscope can result in enough trauma for development of an anal fissure. During childbirths, trauma in the perineum tissue, can also cause a tear that can extend into the anoderm.The most common location where this disease is diagnosed is the part of the anus, which is closest to the spine.

Other causes for development of this malady are infectious diseases are viral infections like herpes, gonorrhea, syphilis, chancroid, chlamydia, tuberculosis and HIV. Also patients who suffer from Crohn’s disease, 4% of such patients develop anal fissures as the primary manifestation of their disease. Anal fissures are diagnosed by physical examination of the patients. In case rectal bleeding is present sigmoidoscopy and colonoscopy are done at times to confirm the diagnosis. Even in the case of acute fissures, non-operative therapies proves successful in majority of the patients. Initial treatment of this painful colorectal disease involves prescribing stool softening medications, followed by increase in liquid intake and sitz bath.

Sitz bath increases the flow of blood to the anus, which relaxes the rectal spasm and cleans the anus without irritating the anoderm, if done particularly after passing of the stool.

Treatable by medical professional Require medical diagnosis Lab test required Short-term: resolves within days to weeks Non communicable
Symptoms
Blood in stool Constipation Itchiness around the anus

Popular Health Tips

Don't Confuse Fissure With Fistula!

MBBS, MS- General Surgery
General Surgeon, Ambala
Don't Confuse Fissure With Fistula!

If you think fissure and fistula are the same, you are mistaken. While the term fissure refers to the tear of the skin, fistula refers to the abnormal tube-like passages or connections between organs. Fissures get cured with or without treatment in a few days to few weeks, and do not lead to complications. On the contrary, fistulas when left untreated may lead to complications.

So, read on further to know about the distinction, how to recognize the symptoms and avail treatment.

What is anal fissure?
An anal fissure can occur due to various reason, such as prolonged diarrhea, anal sex, vaginal childbirth, rectum cancer, etc. For majority of the cases, it is usually due to constant constipation or strained bowel movements, that tear down the muscles controlling the sphincters to the inner rectum or the anal canal.

What is anal fistula?
Anal fistulas are not tears but abnormal abscesses near the anus, filled with pus. In fistula, a tunnel is formed under the skin which connects these abscesses to the infected glands. Fistulas are usually the results of present or previous abscesses. If ignored or left untreated, one single fistula can lead to the development of a more complex fistula, where the single fistula tract ends up creating multiple openings.
 

 

Symptoms of anal fissure and anal fistula
Some of the common symptoms of an anal fissure are excruciating pain in the anal area every time the bowel movement occurs, constant itching or burning sensation in and around the anus, bloody stool and visible tears and cracks around the anus.

For anal fistula, some of the very common symptoms are a throbbing pain in the anus, which continues to increase, difficulty in sitting down for longer period, swelling and redness around the anus, accompanied by skin irritation, discharge of blood and pus, and at times fever.

Treatment options
To completely cure anal fissure and fistula, it is the various surgical options that are the most effective ones. However, when diagnosed in its earliest form, medications like antibiotics, analgesics, and antipyretics can often help. It is solely depending on the location, type, and size or severity of the fistula or fissure, the treatments may vary from person to person and so does the recovery time.

Though, these conditions cannot be cured with dietary changes or exercise, following a healthy diet can boost healthy bowel movement, reducing chances of constipation or diarrhea that results in fissures.
Prevention is always better than cure. Therefore, it is essential that you visit the nearest medical facilities once you notice any signs of fissure or fistula , to avail the right treatment and get relief from the symptoms quickly. In case you have a concern or query you can always consult an expert & get answers to your questions!

3571 people found this helpful

Fistula-in-Ano or Anal Fistula - How It Can Be Treated?

MS, FACRSI
General Surgeon, Jabalpur
Fistula-in-Ano or Anal Fistula - How It Can Be Treated?

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Symptoms

  1. Pain- Constant pain which gets worse when sitting down
  2. Irritation around the anus, like swelling, redness and tenderness
  3. Discharge of blood or pus
  4. Constipation or pain while evacuation
  5. Fever

Diagnosis
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

 

Treatment
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

  1. Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
  2. Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.

Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes in continence. Patients usually don’t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation. If you wish to discuss about any specific problem, you can consult a General surgeon.

1840 people found this helpful

All About Anal Fissures

MBBS, MS - General Surgery , DNB (General Surgery), MNAMS (Membership of the National Academy), Fellow HPB Surgery & Liver Transplant (Singapore) , FICS - RPSLH - RPSLH
Gastroenterologist, Hyderabad
All About Anal Fissures

Anal fissures are the small tears formed in the anal lining. They are also known as anal ulcers. An anal fissure causes a lot of pain and bleeding during your bowel movements. Usually a fissure heals automatically in a few days time. It can be treated with simple home remedies as well.

Causes:

  1. You can suffer from an anal fissure if you pass hard and large stools. 
  2. Also strained childbirth or suffering from violent spells of diarrhea might get you an anal fissure. 
  3. Chronic constipation may also be cause of a fissure. 
  4. Other rare causes may be anal cancer, HIV, tuberculosis or herpes. 

Individuals of all age groups can suffer from anal fissures. It is not a very serious problem and heals on its own in a few weeks. Although it can heal itself, there are certain treatments which can help relieve the pain you get from an anal fissure.

Symptoms:
An anal fissure has quite a lot of symptoms for you to understand what you are suffering from:

  1. There will be a very visible tear around the anal region. You will be able to spot the tear on the skin very easily.
  2. A small lump of skin may form next to the tear.
  3. When you will be undergoing your bowel movements, you will feel a very sharp pain in the anal region.
  4. You will find spots of blood on the stool passed.
  5. You will also feel a burning or an itching sensation in the anal region.

Treatment:
Although most fissures do not require treatment, there are a few remedies that will help cure them faster:

  1. Stool softeners: You get certain medicines at the chemist, which are known for their stool softening functions. These stool softeners help to soften the hard stools and initiates smooth bowel movements.
  2. Eat fibrous foods: Eat foods rich in fiber like fruits, whole grain cereals, raw vegetables, etc.
  3. Take warm baths: Take a bath in warm water as it relaxes your anal muscles, helps to relieve irritation in the region, and increases blood flow in the anorectal region.
  4. Use ointment: Apply nitroglycerin ointments and topical pain relievers to promote blood flow to the anal region and to relieve discomfort from the region respectively.

Related Tip: "What Are Anal Fissures and How Can You Deal With Them?"

3752 people found this helpful

Common Anorectal Diseases - Know Their Symptoms And Treatment Options!

MBBS Bachelor of Medicine and Bachelor of Surgery, MS - General Surgery
General Surgeon, Ludhiana
Common Anorectal Diseases - Know Their Symptoms And Treatment Options!

Anorectal diseases, affect the rectum or the muscles surrounding the analregion. Some of these conditions can be difficult to live with, as the symptoms interfere with everyday life. Here is a look at two of the most common anorectal diseases, their symptoms, and their treatment.

Anal fistula
Anal fistula is an unnatural tunnel formation between the anus and a portion of the surrounding skin. It is usually caused due to an infection or blockage in the anal cavity. Here are some common symptoms associated with anal fistulas-

If you have anal fistula, you need to seek immediate treatment. Here are some forms of treatment used to manage the condition-

  1. No medication is able to treat the condition and surgery is the only available option.
  2. If the fistula is not too close to the anus, doctors will simply cut open the tunnel formed inside and let the body heal on its own.
  3. A plug may be inserted to close off the tunnel
  4. In some cases, a tube like instrument is inserted into the fistula tunnel to drain out the waste material prior to the surgical procedure.

Anal fissure
A small tear or cut in the lining of the anus is known as an anal fissure. Often, such a tear causes discomfort and bleeding during bowel movement. Its symptoms include-

  1. A tear near the anus, which is visible to the naked eye
  2. Sharp pain during bowel movement
  3. Burning or itching sensation in the anal region
  4. Bright red stools.

Here is a look at the treatment options open to you, if you suffer from anal fissure-

  1. Laxatives and stool softeners
  2. Changing the diet to include more fibrous foods
  3. Submerge your anus and affected region in warm water. This is known as a sitz bath.
  4. Nitroglycerin ointment is applied to the tear to increase blood flow to the area.

Consult a surgeon immediately if you notice signs of either of these disorders near your anal region. The doctor will advise you regarding the treatment.

1904 people found this helpful

VAAFT (Video Assisted Anal Fistula Treatment)

MBBS, DNB ( General Surgery )
General Surgeon, Indore
VAAFT (Video Assisted Anal Fistula Treatment)

Nowadays new and effective method to treat high and complex fistula known as vaaft. Advantage of vaaft like minimal post operative pain reduced hospital stay, requires very small incision instead if very long incision, sphincter preservation in the high fistula, you can get back to work soon as compare to conventional fistula surgery 

Popular Questions & Answers

I have re-current of anal fissure that is very painful. If I miss 1 day of bowel movement the I have anal fissures the next day. What should I do?

M.S. (Ayurveda), Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Delhi
You should start taking Sitz bath (hot water tub bath) followed by application of Sushruta ointment and Lekhan powder in anal canal. Put 5 ml of Sushruta oil in anal passage in night. For easy evacuation of bowel movement you should take 1 tea spoon of Sushruta churna with warm water in night. To get these medicines and for further support and appointment; you may call reception at Sushruta Ano Rectal Institute.

I am having problem of anal fissure it hurts a lot what can I do to cure this any medicine or gel or cream easily available? Please help m appearing in Medicals does it is a type of piles coz this will reject me please help?

BHMS
Homeopath, Noida
Take home cooked, fresh light food. Take a lot of green vegetables n fruit. It contains a lot of fiber which will help reduce tendency for constipation Maintain active life style Curd is good for u. Avoid fast foods, spicy n fried foods For details you can contact me.

I am suffering with anal fissures from last 6 months, I consult one doctor he gave me Diltiazem cream. I have constipation problem, stool comes hard. After my stool, anus pain coming and it stays around 12 hours with me. Please advise me good medicine for fissure and for stool soft.

DNB GENERAL SURGERY, MBBS, National Board Of Examination
General Surgeon, Mumbai
Hello sir please go through my article What is an anal fissure? — An anal fissure is a tear in the lining of the anus, the opening where your bowel movements come out (figure 1). Anal fissures cause pain, especially during a bowel movement. There is a muscle that wraps around the anus and holds it shut. It is called the "anal sphincter. The sphincter gets tense when the anus is injured. In people with anal fissures, the sphincter goes into spasms, which can lead to further injury. What causes anal fissures? — An anal fissure is most often caused by having a hard, dry bowel movement. What are the symptoms of an anal fissure? — Most people who have an anal fissure feel a tearing, ripping, or burning pain when they have a bowel movement. This pain can last for hours. Some people also bleed slightly when they have a bowel movement. They might see bright red blood on the toilet paper or on the surface of the bowel movement. Some people with an anal fissure also have itching or irritation around the anus. Should I see my doctor or nurse? — Yes. See your doctor or nurse if you bleed when you have a bowel movement. Are there tests I should have? — Your doctor or nurse can check whether you have anal fissure by gently spreading your buttocks apart and looking at your anus. If you have had bleeding, your doctor or nurse might send you for a test called a "sigmoidoscopy" or a similar test called a "colonoscopy" (figure 2). For these tests, the doctor puts a thin tube into your anus and up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon and check for causes of bleeding. The doctor will usually wait until your anal fissure has healed before doing the test. What can I do on my own to help an anal fissure? — You can: ●Eat more fiber – Eating more fiber can help keep your bowel movements soft. Fiber is found in most fruits, vegetables, and whole grains (figure 3). Doctors suggest eating 20 to 35 grams of fiber a day. The nutrition label on packaged foods can show you much fiber you are getting in each serving (figure 4). ●Take a stool softener – Stool softeners are medicines that help make your bowel movements easier to pass. You can buy them without a prescription. One stool softener that is often used is called docusate (sample brand name: Colace). ●Soak your buttocks in a "sitz bath" – Soaking your buttocks in 2 or 3 inches of warm water is called taking a "sitz bath. Do this 2 to 3 times a day for 10 to 15 minutes. Do not add soap, bubble bath, or anything else to the water. Sitz baths help relieve pain and relax the sphincter. How are anal fissures treated? — Treatment for anal fissures involves steps that are similar to the things you can do on your own. For the first month of treatment, doctors recommend that people: ●Take fiber supplements, such as: •Psyllium (sample brand name: Metamucil) •Methylcellulose (sample brand name: Citrucel) •Calcium polycarbophil (sample brand name: FiberCon) •Wheat dextran (sample brand name: Benefiber) ●Take a stool softener, such as docusate (sample brand name: Colace). ●Use nitroglycerin or nifedipine cream, prescription medicines that relax the anal sphincter muscle and help the fissure heal. ●Take sitz baths (see above). If these steps to do not work, doctors can try other treatments, such as: ●Botulinum toxin ("BoTox") – This is a shot that can help the anal sphincter muscle relax and heal. It can help, but it can also cause short-term problems with leaking of gas or bowel movements. ●Surgery – During surgery, the doctor makes a small cut in the sphincter to help it relax. This surgery works in most patients, but doctors offer it only to people who do not get better with other treatments. Surgery can cause lasting problems with leaking of gas or bowel movements. FOR FURTHER QUERIES PLEASE BOOK AUDIO CONSULT TO HELP ME GUIDE YOU MORE TAKE CARE.
3 people found this helpful

I am feeling intense urge but stool is not coming, many years ago once stool became hard and got severe anal fissure. So,this time if I use rectal area then stool will come easily ?so that again fissure do not occur.

DNB GENERAL SURGERY, MBBS, National Board Of Examination
General Surgeon, Mumbai
Use syrup lactulose at night time and increase amount of fibre in your diet for further queries please book audio consult take care.

HI, I’m suffering from swelling in large intestine both sides Also suffering from loose motions and anal fissures from 2 years.

MCh(Minimally Invasive & Robotic Surgery), MS - Surgical, MBBS
General Surgeon, Guwahati
You need to be ruled out of IBS. Inflammatory bowel syndrome. If positive for this, you will be prescribed few medicines only. Kindly consult nearest gastro meteorologist.

Table of Content

What is Anal Fissure?

Causes :

Play video
Anal Fissure
Hi, I am Dr Ashok Gupta, practising since last 37 years as a general surgeon, Laparoscopic surgeon and Gastroenderoscopist. Today we are going to discuss the most common problem that is Anal Fissure.

Anal Fissure is such a problem which is very prevalant in our community, may be the raeson of the pattern of the diet, constipation, inactivity, Obesity Diabetes and other inactive way of diet. Anal fissure is the breech in the skin which are there from the anal walls to the rectum in lower part. This is about 2-3 cm in size and this anoderm is more sensitive and lacking in sweat glands and hairs. Once the hard motion is being passed or the person is constipated, there occurs a breech in the skin which leads to severe pain while passing the stool sometime otherwise also. This linear breech is not going to heal by any chance, it mostly requires medical interference. Medical treatments are responsive at times but once it get failed, then surgery is only the answer.

The surgery is very simple in this case. We just relax the sphincter because sphincter always give the spasm to the fissure which is not allowing it to heal and it always gives the problem in later times. The surgery being done under general anaesthesia and spinal anaesthesia, just to relax the sphincter.

After the cure is there, so it is not going to create problems. But the complicated anal fissure has to be dealt with the "fissure act me" in which the fissure is being removed.

If you have nay query or if you want to contaact me, you can come to my clinic Tirupati Medical Centre in Malviya Nagar. Also, you can contact me through Lybrate.
Play video
Benign Anorectal
Hello friends, I am Dr. Sandip Banerjee, and I am a consultant laparoscopic surgeon, bariatric and colorectal surgeon. I am practicing in my clinic, named as Pelvinic. I am also a head surgeon in Apollo Spectra Kailash Colony.

Today I am going to talk about benign anorectal conditions which are problems involving your anus and rectum, and which is involving a large amount of population in our country. So the primary problem arising out of this is because of a constipation. Constipation is affecting almost 13 % of the population, much higher than what diabetes and hypertension are affecting our population. So because of a constipation there are few problems which day in day out in the routine life, and involves any group, any class of patients.

The first thing I m going to discuss is a fissure in anus. Fissure is a painful condition in anus which mostly is because of an ulcer formation, or the breach of skin in the anus which develops due to the passage of hard stool. And the main symptoms of this is a painful difficulty to sit, postural problems, and painful defecation, with a minimum association of passage of minimum amount of fresh amount of blood during defecation. The solution lies in the treatment with medical management mostly. And 70 to 80 percent of the patient benefit out of the medical management. Only the remaining of the patients who develop a chronic fissure, who are not being cured by medical management, they are the one fit for surgery.

The second one is in hemorrhoids, which are called piles. So all of us do have an anal cushions normally, and which once gets prolonged due to chronic straining developed pathological piles. Now, the piles were graded according to the size, and the type of problems which patients are facing. It can be graded from grade one to grade four. The initial grade piles, which are grade one and two, in which the patients do have problems related to like bleeding or mucous discharge or some sort of difficulty while passing stool. But there is no history or no complaints of something coming out of the anus. So they are the early grade piles. In early grade piles, either they need some sort of a treatment in terms of medicine, or at times when it is really bothersome, then we do advise some nonsurgical treatment like laser radiofrequency ablation, cryotherapy, and even banding. But for the haemorrhoids which are quite big, like grade three and four, in which the patients mainly complain of something coming out of the anus, and they need to manually reposition it. So, they are the one which needs a definitive surgery. And the surgery which has come late in a high success rate is the stapler surgery for haemorrhoids. The stapler surgery which has been used for last 10-15 years is seen with a lot of success, that has revolutionized the piles surgery, in which the patients only need a day in a hospital, goes back to home, without any pain, without any problems thereafter. The chances of recurrence even less than 0. 001%. Then there are some acute conditions in which you develop an abscess in the anus, and you must know that abscess in the anus should always be drained. It should always be surgically drained, and there is no other way just to linger it on with medication.

Because if an abscess in the anus or the perianal region is being neglected, that abscess may develop into a tract which is called a fistula, and once you have developed a fistula then it s very difficult to treat. Now, fistula in anus is a tract which is connecting the outer skin with the inner anus. So what happens is that a patient, once they develop a fistula, they have typical complaints of persistent perianal discharge in forms of pus, and then suddenly the discharges end, and then patients are quite okay. For few days, the patient may develop some swelling, there is severe pain, and then sudden discharge again comes back. So in this way the cycles goes on and develops into a complex tract.

It s very important to know what is the tract of a fistula. While treating fistula we see whether it san high or a low fistula. So low fistula need not need any further imaging things, because out of experience we can find it out while doing proctological examinations that it s a low fistula. Low fistula has a very high success rate of surgical cure. Whereas in high fistula it requires some sort of an MRI imaging. MRI imaging helps us to know the different kind of tracts, and once knowing the tracts we need to perform some different forms of surgery based on the tract. It can be a laser, it can be radio frequency ablation, it can be a vaaft surgery, it can be a lift surgery. Based on the complex nature of the fistula, the cure rate is quite. The cure rate is having a recurrence rate of 3-7% world over. And I have been using radio frequency ablation for different types of fistulas. Even laser has been applied, and I ve met with a quite a good amount of success in my patients.

The other 2 things which I want to discuss is about rectal prolapse. Now the patients do complain of something coming out as a chunk through the anus while defecation, and it s a quite a big amount as compared to hemorrhoids. Patients do have a problem associated with rectal prolapse, either they have chronic diarrhoea, or constipation. So it can be either constipated prolapse or a diarrheal prolapse, and for that too it needs a treatment, and definitive surgery. Definite treatment is a surgery, and it involves a laparoscopic cure from the abdomen. And the last is pilonidal sinus. And pilonidal sinus develops as a small chronic discharging fissure in between the anus buttocks, and that also needs a very good flap surgery. So hope you will like this information, and for any type of solution, any type of cure, you can contact me either in Pelvinic, or through Lybrate, or in Apollo Spectra Kailash Colony. Thank you.

And the last is pilonidal sinus. And pilonidal sinus develops as a small chronic discharging fissure between the buttocks, and that also needs a very good flap surgery.

I hope you like this information, and for any type of solution or any type of cure, you can contact me either in Pelvinic, or through Lybrate, or in Apollo Spectra Kailash Colony. Thank you.
Play video
Anal Fistula
A fistula is an abnormal connection between an organ and another structure. Fistulas develop when an organ becomes inflamed or injured. They are a very common complication of inflammatory bowel disease (IBD), occurring more frequently in Crohn s disease than ulcerative colitis.
Play video
Anal Fistula
An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. There are some effective ayurvedic remedies available for treating the same too.
Play video
Anorectal Disorder - Piles, Fistula, Fissure And Pilonidal Sinus
Anorectal disorders are a group of medical disorders that occur at the junction of the anal canal and the rectum.Most people experience some form of anorectal disorder during their lifetime. Primary care physicians can treat most of these disorders, however, high-risk individuals include those with HIV, roughly half of whom need surgery to remedy the disorders.
Having issues? Consult a doctor for medical advice