An anal fissure is one of the most common anorectal problems amongst most people. An anal fissure is largely associated with a high anal sphincter that involves high pressures.
This is basically defined as a small tear that is considered to be thin that lines the anus.
Anal fissures have a tendency to cause pain and bleeding during bowel movements. Various over the counter medications and anorectal cream are available that have been proven useful for alleviating the pain to some extent. Although the severe cases of anal fissures may require surgery.

Causes And Symptoms:

It is advised to see your doctor if you feel any pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. The causes and symptoms may include:

  • Passing hard or large stools
  • Constipation and straining during bowel movements
  • Chronic diarrhea
  • Anal intercourse
  • Childbirth
  • Crohn’s disease or another IBD
  • Anal cancer / HIV

You might feel some itching or pain that can range from minor to severe depending on your condition. A small lump might occur as well on the skin near the fissure causing pain that may lead until several hours.

Diagnosis Of Anal Fissure:

Your doctor is most likely to go through an in-depth survey for your medical history while performing a physical exam that involves gentle inspection of the anal region. The fissure’s location often gives the clue and hints about its cause. A fissure that occurs on the side of the anal opening, is more likely to be a sign of another disorder, such as Crohn’s disease. Your doctor might recommend further testing if they think you have an underlying condition:

  • Anoscopy: This way, a tubular device is inserted into the are of your anus which helps the practitioner to visualize the rectum as well as the anus.
  • Sigmoidoscopy: This process also involves inserting a thin and majorly a flexible tube with a tiny video into the bottom of your colon area. This is only performed for individuals who are under the age of 50, who have no risk factors for intestinal diseases or colon cancer.
  • Colonoscopy: Another flexible tube to be inserted into your rectum to inspect the entire colon properly. This test may be done if you are older than age 50 or in some cases where you have risk factors for colon cancer or other symptoms such as continued abdominal pain or diarrhea.

Treatment Of Anal Fissure:

Anal fissures are considered to heal within a few weeks if you take indispensable steps such as lifestyle factors to alleviate pain. This includes soaking the region in warm water for 10 to 20 minutes several times a day, especially after the completion of your bowel movements, can help relax the sphincter and promote healing. Adding fiber to your diet at least 25-30gms each day as it will help to make your stool softer and improve the fissure healing. You can also include fruits, vegetables, and nuts or whole grains. Having enough water consumption help prevent constipation.

Non-Surgical Treatments:

If you feel your fissures are shrinking with home remedies, you can also use suppository supplements such as anorectal cream that can help relax the sphincter and promote healing.

  • Externally applied nitroglycerin: This will help to increase blood flow to the anus area and promote healing faster. Nitroglycerin is generally considered as the medical treatment of choice at the time when other conservative measures fail to work effectively. Severe side effects are noticed such as intense headaches.
  • Topical anesthetic creams: These are used to relieve pain caused by the anal fissures, and the tears on the skin.
  • Botox injection is also used widely in order to paralyze the anal sphincter muscle and relax spasms.
  • Blood pressure medications: Oral nifedipine or diltiazem (Cardizem) can help relax the anal sphincter. These medications can be taken by mouth or applied externally and may be used when nitroglycerin seems to be ineffective or causes significant side effects.

Surgical Treatment:

If you are suffering from a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend going further for a surgery. Doctors usually perform a procedure that is commonly known as lateral internal sphincterotomy (LIS). This involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing faster and efficiently.

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