Anal Fissures

An anal fissure is a small tear or open sore (ulcer) in the lining of the anal canal. Fissures can be quite painful and cause bleeding with bowel movements and are often mistaken for hemorrhoids because the symptoms are similar. An anal fissure can last up to 6 weeks (acute anal fissure), but if persistent, can last for longer periods and become a chronic condition.

Anal fissures are noted as a common problem for adults and children. Based on recent research, a higher incidence is seen in women from 12 to 24 years of age, and men 55 to 64 years of age, however, anal fissures can occur at any age, even in very young children.

Causes & Risk Factors
Anal fissures are usually caused by injury to the lining of the anal canal, such as that caused by a hard bowel movement (commonly in cases of constipation). While in some cases no clear cause is identified, other possible causes include:

  • Constipation (large, hard stool can cause lesions in the anal area);
  • Persistent diarrhea;
  • Inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis);
  • Having unusually tight anal sphincter muscle (increased tension in the anal canal makes it more susceptible to tearing);
  • Pregnancy and childbirth;
  • Sexually transmitted infections (STI) can cause infection and damage the anal canal.

Anal fissures do not heal easily because the pain felt during a bowel movement can cause a spasm of the sphincter muscle and decrease the blood flow to the area, which interferes with the healing process. This cycle is repeated with each bowel movement, resulting in more pain, more spasms, and even less blood flow each time you pass stool.

In addition to the causes listed above, risk factors related to anal fissures can include:

  • Straining during bowel movements;
  • Colorectal surgery
  • Prior anal surgery;
  • Anal intercourse;
  • Tumors.

Symptoms
The most common symptom of an anal fissure is intense, sharp pain in the anal area during defecation followed by a deep, burning pain that can last for several hours. Most people notice traces of bright red blood (fresh blood) in or on the surface of their stool, or on the toilet paper.

Prevention
Preventing and treating anal fissures begins with changes in diet to help form softer stool that is easier to pass. A diet high in fiber makes stool bulkier, while drinking more water and taking a stool softener can help stool pass more easily; this will reduce straining and allow the fissure to heal.

The fear of pain may cause people to postpone having a bowel movement, but this can cause the stool to become harder, increasing the risk of constipation and tears. Going to the washroom when you feel the urge to will aid in preventing anal fissures and also healing existing fissures. Frequent or regular exercise can also aid in preventing constipation. It is also recommended to avoid straining and sitting on the toilet for a long period.

Treatment
Anal fissures typically subside within a few weeks without medical intervention; however, they can easily resurface if the underlying cause is not treated.

In some cases, medication such as pills, suppositories, creams or gels may be prescribed to help relax the sphincter muscles and accelerate the healing process. Topical anesthetics may help ease the pain and relax the sphincter, as well as soaking in sitz baths after a bowel movement.

Surgery may be recommended for persistent cases of anal fissures where home remedies and medical treatment have not been successful. Often times, surgery is very effective in treating anal fissures, but minor complications such as temporary or permanent loss of bowel control (bowel incontinence) may arise.

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