They are equally common in both sexes, and most frequently affect people aged 15 — 40 years. Spasm of the anal sphincter or local ischaemia can predispose people to, or worsen, anal fissures. Atypical anal fissures may develop in people with Crohn's disease, sexually transmitted diseases particularly HIV, syphilis and herpes simplex , anal cancer, local trauma anal intercourse , tuberculosis or receiving chemotherapy.
Spontaneous resolution occurs in one-third of people, usually within six weeks. Anal fissures that persist longer than this are considered chronic and should be managed more intensively. Topical glyceryl trinitrate is now available, fully subsidised, with Special Authority, as a treatment option for people who have had an anal fissure for at least three weeks. Where medical management fails to resolve symptoms and help heal the fissure, referral to secondary care for surgery or botulinum toxin treatment is usually required.
Intense pain during defecation that often persists for one to two hours afterwards is the primary symptom of an anal fissure. Perform an examination to help confirm a diagnosis. Anal fissures are not always visible on examination; however, examination is useful for ruling out other causes of pain and bleeding such as haemorrhoids, abscesses and viral ulcers. Typical features of a chronic anal fissure include an ulcerated lesion, a sentinel pile at the base of the fissure resulting in a permanent skin tag and enlargement of the anal papillae.
Advise the patient to increase dietary fibre and fluid intake to keep bowel motions soft. The importance of correct anal hygiene and the need to keep the anal area dry should be emphasised. Regular sitz baths sitting in warm water up to the hips can help to relax the sphincter.
If lifestyle and dietary interventions are insufficient, or if the fissure is severe, a stool softener, e. If the fissure fails to heal within three to six weeks, topical nitrates or topical calcium channel blockers should be used. All topical treatments for anal fissures should be applied for at least six weeks to allow re-epithelialisation of the fissure. A topical nitrate, e. How is an anal fissure diagnosed? The exam may include: Looking at the fissure by gently separating the buttocks.
A digital rectal exam. The doctor inserts a gloved finger into the anal canal. This involves using a short, lighted scope to look into the anal canal. How is it treated? There are several steps you can take to relieve your symptoms and help the fissure heal: Try to prevent constipation. For example: Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber. Drink plenty of fluids.
Get some exercise every day. Take a fiber supplement, such as Benefiber, Citrucel, or Metamucil, every day if needed. Read and follow all instructions on the label.
Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. Take your time and do not strain when having a bowel movement. But do not sit on the toilet too long. Try taking stool softeners or laxatives to make bowel movements less painful. Ask your doctor how long you should take laxatives.
Sit in a tub filled with a few inches of warm water for 20 minutes, 2 or 3 times a day. This is called a sitz bath. It soothes the torn tissue and helps relax the internal anal sphincter.
Do not put soaps, salts, or shampoos in the water. These may help soothe anal tissues. But fiber and sitz baths help symptoms more. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
Instead of using toilet paper, use baby wipes or medicated pads, such as Tucks pads or Preparation H wipes, to clean after a bowel movement.
Anal fissures are common and affect people of all ages. They occur when the anal tissue stretches beyond its limit, creating the tiny tear — or crack.
Overstretching usually occurs when passing large, dry, hard stool. The pain from the tear triggers the anal sphincter muscles to spasm and tighten, cutting off blood supply that may delay healing of the tear. This cycle of pain, muscle spasms, and lack of blood flow then occurs with every bowel movement. Treatment for an anal fissure centers around disrupting this pattern so the tear can heal. With early diagnosis and treatment, most anal fissures heal within eight weeks.
However, if you ignore the warning signs and put off getting the care you need, you may end up in a cycle that ultimately leads to a chronic anal fissure. The most common warning sign of an anal fissure is severe pain during a bowel movement. The pain may last at that level for a few minutes or a few hours after your trip to the bathroom.
The severe pain you feel during and after a bowel movement may make you fearful of going. Most anal fissures heal with home treatment after a few days or weeks. These are called short-term acute anal fissures. If you have an anal fissure that hasn't healed after 8 to 12 weeks, it is considered a long-term chronic fissure. A chronic fissure may need medical treatment. Anal fissures are a common problem. They affect people of all ages, especially young and otherwise healthy people.
Anal fissures are caused by injury or trauma to the anal canal. Injury can happen when:. Fissures can also be caused by a rectal examination, anal intercourse, or a foreign object.
In some cases, a fissure may be caused by Crohn's disease. Many experts believe that extra tension in the two muscular rings sphincters controlling the anus may be a cause of fissures.
The outer anal sphincter is under your conscious control. But the inner sphincter is not. This muscle is under pressure, or tension, all of the time. If the pressure increases too much, it can cause spasm and reduce blood flow to the anus, leading to a fissure. This pressure can also keep a fissure from healing. Sometimes an anal fissure may be a painless wound that won't heal. It may bleed from time to time but cause no other symptoms. A doctor can diagnose an anal fissure based on your symptoms and a physical examination.
The examination may include:. The doctor may wait until the fissure has started to heal before doing a rectal examination or anoscopy. If an examination needs to be done right away, medicine can be used to numb the area.
During an examination, a doctor can also find out whether another condition may be causing the fissure. Having several fissures or having one or more in an area of the anus where fissures usually don't occur can be a sign of a more serious problem, such as inflammatory bowel disease or a weakened immune system. Most short-term anal fissures can heal with home treatment in 4 to 6 weeks. Pain during bowel movements usually goes away within a couple of days after the start of home treatment.
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