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Anal Fissures - What Treatment Options Should You Follow?

Written and reviewed by
MS - General Surgery, MBBS Bachelor of Medicine and Bachelor of Surgery, FAIS, Fellowship In Minimal Access Surgery
General Surgeon, Mumbai  •  25 years experience
Anal Fissures - What Treatment Options Should You Follow?

Anal fissures arereferred to as a small cut or a tear in the lining of the anus. The cut or crack on the skin is the main cause of the severe pain. The person might observe bright red bleeding during and after passing bowel movements. Sometimes, when the fissure goes deep it exposes the muscle tissue underneath of the anus. An anal fissure might occur due to labor, i.e. during childbirth, straining or pushing during bowel movements, constipation, diarrhea, or certain medical conditions such as inflammatory bowel disease, cancer, and infection.

Individuals of all ages can be affected by anal fissure, including infants and young children. The common cause being constipation. This condition is not a serious issue. The tear can be treated or it might get heal on its own within a month or so. However, if it persists above two months, then it is considered a chronic or long-term fissure.

The symptoms of an anal fissure include:

  • Visible tear or cut in the skin around the anus
  • A small lump of skin or skin tag present next to the cut
  • Severe pain in the area during a bowel movement
  • Streaks of blood on stools or spotting on the dry tissue paper after wiping
  • Burning sensation or itching in the anal area

Causes


Mostly an anal fissure occurs while passing very hard or large stools. This could be due to chronic constipation or frequent diarrhoeal episodes that can lead to tearing of the skin around the anus. Other causes of occurrence of an anal fissure are Crohn’s disease or inflammatory bowel disease, straining during labor, over tight or spastic anal sphincter muscles, or decreased blood flow to the anorectal area.
A fissure might also occur due to anal cancer, HIV AIDS, tuberculosis, syphilis, and herpes.

Treatment
Mostly anal fissure does not require extensive treatment. Some of the home remedies can help treat anal fissure and relieve the discomfort caused. The home remedies used for treatment are:

  • You can use over-the-counter stool softeners
  • Drink more water or fluids
  • Take fiber supplements
  • Have high fiber diets by including fibrous foods, such as raw fruits and vegetables, dry fruits, cereals, etc.
  • You can even take warm sitz bath to relax and relieve the pain in the anal muscles and it will also help to increase the blood flow to the anorectal area.
  • You can apply an ointment containing nitroglycerin to the anus in order to promote blood flow, or
  • Hydrocortisone cream to help with healing the inflammation.
  • You can apply topical pain reliever, lidocaine to the anus to relieve yourself from discomfort.
  • An ointment with calcium channel blocker can be used to relax the sphincter muscles and will help to heal anal fissure.
  • Botox injections into anal sphincter can also heal anal fissure. Spasms in the anal area can be prevented through Botox injections. This injection temporarily paralyzes the muscle. Due to this, the anal fissure gets time to heal and prevent the formation of new fissures.
  • If the fissure is not treated with home remedies, the doctor might recommend anal sphincterotomy. This surgery involves making a small incision in the anal sphincter to relax the muscle, thus healing the anal fissure.

Prevention
An anal fissure can be prevented by taking following preventive measures:

  • Keep anal area dry
  • Proper cleaning of the anal area with mild soap and warm water
  • Drink plenty of water and fluids to prevent constipation
  • Avoid consumption of sharp foods that are difficult to digest such as nuts, popcorn, etc.
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