Anal Fissure: Symptoms, Causes, Treatment And Cost

Anal fissure can be described as a cut or tear on the skin, in or around the anal area. It can cause extreme pain accompanied by red blood spots during stool.

Fissures are known to affect people of all ages, however, it predominantly remains common among infants or middle-aged people.

Fissures can often be taken off at home and do not necessarily pose any health hazard.

Stool softeners or some pain relief medications can help in mild cases. If nothing works, then your doctor might ask for anal fissure surgery.

When a patient suffers from anal fissures, he or she may show one or more of the following symptoms:

• A visible tear around the anal
• A lump of skin next to the tear
• Burning and itching around the tear
• Bowel movements become difficult and harder to pass
• Streaks of blood spots in the stool or on the toilet paper
• Foul-smelling discharge
• Constipated stomach

The symptoms of anal fissure in males and anal fissure symptoms in females are very similar. These symptoms are not the same for all and can differ. To understand your condition better, you should see a doctor once you experience any early symptoms of anal fissure.

If the patient suffers from chronic constipation or frequently experiences diarrhea, he/she is more likely to suffer from anal fissure. Passing a hard stool or putting too much strain may also cause the skin around the anus to tear.

However, these causes of fissures are caused by either constipation or a low-fiber diet which causes hard stool. Not all patients have fissures for these reasons. If your fissure is recurring, does not heal within 6-8 weeks, or is located in a region other than the mid-posterior area of the anus, it could mean that you have an underlying disease, the side-effect of which is fissures.

Anal fissures, as discussed previously, can arise due to multiple factors. They cannot always be prevented, however, certain preventive measures can be taken to lower the risk of acute/chronic anal fissures:

• Always try to keep the anal area dry. After passing the stool and cleaning the area with water, make sure you also dry the area with a clean towel.
• The skin around the anus region is quite soft and tender. Wash the area with a bar of mild soap and water regularly to keep away bacteria and germs.
• Drinking plenty of fluids like water and fruit juices, eating a fibre-rich diet and exercising daily can effectively lower the chances of recurring anal fissures.
• If you are suffering from diarrhoea, consult with your doctor to put you on diarrhoea medications.
• Prolonged symptoms of diarrhoea can aggravate anal fissure symptoms.
• If your child is suffering from anal fissure, changing the diapers at regular intervals is important.
• Keep the baby’s anal area clean and dry to avoid itching and irritation.

If you notice the symptoms of anal fissure, you will need to consult a doctor.

Several complications associated with anal fissures left untreated have been seen over the years. Some of them are as follows:

• Reduced life quality due to constant reminders of pain and discomfort
• Due to the pain, bowel movements become toilsome. Many people avoid frequent stool passing due to this.
• After treatment, there may be possibilities of recurrence
• Clotting in the area and gas formation

In some cases, anal fissures are capable of recovering on their own. However, with the following fissure treatment at home remedies symptoms of anal fissures can subside effectively:

• Including dietary fibre will help stool passing easier, thus causing less pain during bowel movements. Good examples of high-fibre food items are pumpkin seeds, soybeans, legumes, sprouts and beans.
• Drinking more water is always a great anal fissure treatment at home. You can also include food items in your diet that have high water content, like broccoli, cabbage, cucumber, tomatoes, watermelons and lettuce.
• Sitz baths have been proven to ease any pain associated with anal fissures. Available at drugstores, sitz baths are small tubs. They are to be filled with warm water and to be sat on so that the affected area is submerged for about 10-15 minutes. Emollients like Epsom salt can be added as well.

Here are some food items to be incorporated into your diet if you are suffering from anal fissures:

• Papaya: Both ripe and raw papayas help with better digestion. Papayas are also known to be extremely hydrating, containing about 88% water content. Getting enough water in your system can also rule out dehydration and hard stool, associated with constipation.
• Lemons: Bursting with vitamin C, lemons are a great addition to your diet in you have anal fissures. One lemon has around 21% of the daily recommended value (DMV) of vitamin C for an adult. It is an antioxidant that helps in skin health and collagen synthesis. Squeezing a lemon or two in a glass of water not only helps you get this water-soluble vitamin in the body but also adds to your daily hydration.
• Bananas: A great source of fibre, bananas help with passing smoother and softer stools. Make sure your bananas are ripe enough before consumption, as unripe bananas have a high amylase-resistant starch level, known to aggravate constipation further.
• Turmeric: Recognized for its anti-inflammatory and antioxidant properties for centuries, turmeric has curcumin helps in wound-healing and skin disorders.
• Probiotic-rich foods: Food items like curd helps with clearing the digestive tract and smoother bowel passing. The bacterial culture is curd to feed the gut bacteria. You can also consume other probiotic-rich foods like miso, kimchi and sauerkraut.
• Legumes: Chickpeas, lentils and beans are high in zinc content. Zinc deficiency is one of the major causes why there is a tissue injuries like anal fissures in the body. Zinc is also a tremendous source of fibre, known to soften and regulate smoother bowel movements.

Some food items should be strictly avoided when suffering from anal fissure symptoms. They are as follows:

• Spicy foods: Foods with high chilly powder should be avoided. They aggravate the stomach intestines and make stool passing a tedious job.
• Fried foods: It is easy to consume fried snacks, but difficult to digest as they have almost zero fibre content. They are typically made of all-purpose flour which is very hard for your stomach to digest.
• Red meat: Red meat is hard for the stomach to digest, so try to limit or cut down red meat consumption until your symptoms of fissure have lessened.
• Salty foods: Food made with excessive salt can make you dehydrated. This, in turn, makes stool passing hard and is not good for patients with anal fissures.
• Alcohol: Excessive consumption or regular alcohol intake while suffering from anal fissures is not good as it dehydrates the body.
• Processed and packaged foods: They have no fibre content and do not add bulk to the stool. Consuming fresh foods and cutting down on processed or frozen foods is a good option for anal fissures.
• Caffeinated beverages: Drinks like strong tea, milk or black coffee has a tendency to make your nerves active, but they are not good for the stomach, especially for people with anal fissures.

Schedule a visit with your doctor if the symptoms are not showing any signs of lessening after home remedies are done meticulously. You should seek medical help immediately if:

• You are feeling lightheaded, dizzy or faint accompanied by bright red blood from the rectal passage,
• Fevers, foul-smelling discharge, chills along with excruciating pain in the affected area

If you're older than 40, consult with your doctor in case of rectal bleeding. With an early diagnosis, serious diseases like colon cancer can be ruled out.

Two types of surgical procedures can be followed

If painkillers and laxatives do not help, your doctor may prescribe you the following medications for anal fissure treatment:

• Glyceryl trinitrate: If your symptoms of anal fissure do not show any signs of getting better, a medication called glyceryl trinitrate (GTN) may be prescribed. It is an ointment applied on the anal canal, typically twice a week. GTN works by expanding the blood vessels around the anal region, thus allowing more blood flow in the area and relieving the area of pain, itching and swelling.
• Topical anaesthetics: These are prescribed when the pain in the anal area is excruciating. Anaesthetics help numb the pain, especially before you go for bowel passage. Topical medications are rubbed directly on the affected area. Although they do not necessarily heal the area but have an impact on easing the pain. Lidocaine, in either ointment or gel form, is a highly-prescribed topical cream for anal fissures.
• Calcium channel blockers: Topical calcium channel blockers help with easing anal fissure symptoms. They work by relaxing the sphincter muscle and increasing blood supply to the fissure. A good example of calcium channel blockers is diltiazem.
• Botulinum toxin injections: This relatively new treatment for anal fissures have been rendered safe if used in small and prescribed doses. If no other medication works, this toxin injection is used to paralyse your sphincter muscle and does not allow it to spasm, thus easing any sign of pain and relaxing the fissure.

Just like the home remedies, medicines too can only subside the symptoms of fissure in most of the cases. Surgery, on the other hand, is the perfect solution to get rid of fissures instantly.

• Local ointments: After your doctor has done a physical examination of your fissure, he will prescribe local ointments in the form of topical medicines or jellies. They will help with the swelling by easing the pain and inflammation.
• Oral Medicines for anal fissures: Doctors may also suggest anti-inflammatory drugs for easing the pain. Since they can be in tablet, capsule or syrup form, taking them at the right time in the prescribed dose is important. Oral laxatives may also be given to soften the stools.
• Sitz bath: They are quite common in easing the pain. Sitz baths are small tubs available at your nearest chemist. Fill the sitz bath with warm water and sit on it, so that the affected area is submerged in the water. Sit in this position for about 5-10 minutes and repeat 2-3 times a day to get maximum comfort from the pain.

In India, the average fees for a general fissure surgery like sphincterotomy range from Rs. 18,000 to Rs. 50,000 with a success rate of around 92%. If you are wondering how to find all this information, you can directly come to Pristyn Care and find out every single detail about fissure surgery cost and expenses. Pristyn Care also has some of the finest surgeons in the country to provide anal fissure surgeries at a very affordable price.

After the fissure has healed, it can recur easily. It is common for a fully healed fissure to recur after a strained and hard bowel movement or another injury. Even when the pain and bleeding associated with fissures have subsided, it is very important to continue to have a good lifestyle and a balanced diet.

After surgery, certain precautions need to be maintained for a speedy recovery:

1. Any form of strenuous activity should be avoided for at least 1-week post-op.
2. Sitz baths should be taken thrice a day. For the first few days post-op, a sitz bath should also be taken after every bowel movement.
3. Eating fibre-rich food to avoid constipation.
4. Fresh fruits and vegetables to be included in the diet.
5. Drinking 7-8 glasses of water daily.
6. Use the OTC medications and ointments as and when prescribed by the doctor.
7. Follow-ups post-op should be done on time. Usually, the first follow-up with the doctor is after 3 weeks post-op.

Some medications may cause nausea, lightheadedness, dizziness, fever and vomiting. Even after post-op, you may experience these symptoms. If the symptoms are extreme, consult your doctor immediately.

• The pain you used to experience when walking or sitting for stool is slowly lessening
• There is little or no blood on your stool
• The discomfort or itching in the area is also seemingly less
• You are being able to sit down at once without being reminded of the pain

Conclusively, fissures may not be life-threatening but are a cause of embarrassment and discomfort. With proper medication and lifestyle changes, anal fissures can be treatable at home. When medications are not showing any effect, your doctor may opt for surgical methods. The moment you sense the first sign of fissure, you should try some home remedies. Hence, getting the correct opinion of the doctor is of utmost importance and highly recommended.