Anal fissure : Causes-Symptoms-Diagnosis-Treatment


 What is Anal Fissure?

An anal fissure may be a tear within the lining of the arse or anal canal (the opening through that stool passes out of the body). The fissure may be painful and will bleed.An anal fissure is a cut or a tear in the thin, delicate lining of your anus.

The tear often exposes the muscle around the anus, referred to as the anal sphincter. The harm can cause that muscle to spasm, which might pull apart the sides of the fissure even more. The spasms can cause pain and abate the healing. intestine movements may keep the fissures from obtaining better.

What is Anal Fissure?
Anal Fissure

Associate anal fissure is taken into account acute if it recently happened or if you've had it below half-dozen weeks. It's considered chronic if it's been over 6 weeks or it comes back often.

  1. Musculoskeletal system

  1. Anal canal

Medical terms

  • Anal fissures are tiny tears in the anal canal that occur during the passage of hard or large stools. Pain and bright red blood on the toilet paper are common symptoms of an anal fissure. These tears are caused by pressure on the anal canal, which can result from straining during a bowel movement or due to long-term constipation. The pain and bleeding associated with an anal fissure can be relieved with proper medical treatment.

  • An anal fissure is a tear in the lining of the anus, or the lower rectum. It is a common condition that can cause a significant amount of pain and discomfort. Symptoms of an anal fissure include anal pain that may last for several hours after a bowel movement, bright red blood on the toilet paper after wiping, and even visible tears in tissue on inspection. It can be caused by a number of factors, from constipation to childbirth, and is more common in young adults.

  • An anal fissure is a little tear within the thin, damp tissue (mucosa) that lines the arsehole. associate degree anal fissure may occur once you pass arduous or giant stools throughout a viscus movement. Anal fissures usually cause pain and hemorrhage with bowel movements. you furthermore may experience spasms in the ring of muscle at the top of your anus (anal sphincter). Anal fissures are quite common in young infants however will have an effect on individuals of any age. Most anal fissures recover with easy treatments, like inflated fiber intake or sitz baths. Some people with anal fissures might have medication or, occasionally, surgery. 

  • Anal fissure is a tear in the lining of the rectum It usually has severe pain and bleeding. The healing process can be uncomfortable but there are some tips that help to relieve the discomfort while you’re waiting for this anal fissure treatment to work.

  • treatment Eating high-fiber foods such as fruits and vegetables can help you add bulk to your stool This helps the bowels move more efficiently Drinking plenty of water each day also may help soften stools and keeping your bottom clean with toilet paper or a bidet and not wiping too hard will keep the fissure from getting irritated A warm bath two to three times a week can promote healing by relaxing the anal muscles; applying an over-the-counter hemorrhoid cream or suppository may ease discomfort by helping the anal canal relax.

Symptoms Anal fissure

This article discusses the re-examination of clinical manifestations and response to therapy of fissure-in-ano.

Anal fissure is treated with a systematic review. This review looked at the treatment of anal fissure.

A study was conducted to see if glyceryl trinitrate ointment (a type of ointment) is effective in treating anal fissure. A random selection of people were given the ointment, while others were given a placebo. Neither group knew which they were getting. The results showed that both groups improved somewhat, but the people who received the ointment had a much better outcome than the people who received the placebo.

A study found that the optimal treatment duration for glyceryl trinitrate (GT) for chronic anal fissure is 3 months.

Fissure in the anus can be treated with various operations. A Cochrane review found that some operations are more effective than others.

Tailored lateral sphincterotomy is an operation used to treat anal fissure. This procedure involves cutting away part of the sphincter muscle in the side of the anus.

Chronic anal fissures are a medical condition in which the opening between the anus and the rectum becomes chronically inflamed and painful. Lindsey I Jones OM Cunningham C Mortensen NJ.

These are the practice guidelines for managing anal fissures.

Oh, Divine CM Steinhagen RM. Anal Fissure. 20 Year Experience. Dis Colon Rectum

A lateral sphincterotomy ( operation to cut the muscle that controls the sphincter at the anus) is compared to an anal advancement flap (a surgical procedure to widen the opening at the anus). The study found that the lateral sphincterotomy was more successful than the advancement flap in treating chronic anal fissures.

A study was conducted to see if Sphincter-sparing Anal Fissure Surgery (SAF) is more successful than traditional surgery (fissurectomy with anoplasty). For 1 year after the surgery, the results were good - fewer fissures appeared.

This study found that a mucosa advancement flap anoplasty was successful in treating chronic anal fissures.

Anal fissures generally cause a pointy pain that starts with the passage of stool. This pain might last many minutes to some hours. As a result, several patients may strive to not have viscus movements to stop the pain.

Signs and symptoms of an anal fissure include:

  • Pain, sometimes severe, during bowel movements

  • Pain after bowel movements that can last up to several hours

  • Bright red blood on the stool or toilet paper after a bowel movement

  • A visible crack in the skin around the anus

  • A small lump or skin tag on the skin near the anal fissure

When to see a doctor

See your doctor if you have got pain throughout intestine movements or notice blood on stools or toilet tissue when a bowel movement. 

Causes Anal fissure

Fissures are sometimes caused by trauma to the inner lining of the orifice from a bm or different stretching of the anal canal. This may result in a hard, dry viscus movement or loose, frequent bowel movements. Patients with a decent musculus sphincter and muscle are seemingly to develop anal fissures. Less common causes of fissures embody inflammatory bowel disease, anal infections, trauma or tumors.

Common causes of anal fissure include:

  • Passing large or hard stools

  • Constipation and straining during bowel movements

  • Chronic diarrhea

  • Anal intercourse

  • Childbirth

Less common causes of anal fissures include:

  • Crohn's disease or another inflammatory bowel disease

  • Anal cancer

  • HIV

  • Tuberculosis

  • Syphilis

Risk factors Anal fissure

Anal fissures will occur in anyone at any age. The prospect of getting an anal fissure decreases as folks get older. folks that have had fissures within the past are a lot of possible to own them in the future. Factors that will increase your risk of developing an anal fissure include:

  • Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.

  • Childbirth. Anal fissures are more common in women after they give birth.

  • Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. 

  • Anal intercourse.

  • Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

Complications Anal fissure

Complications of anal fissure can include:

  • Failure to heal. An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.

  • Recurrence. Once you've experienced an anal fissure, you are prone to having another one.

  • A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your orifice closed (internal anal sphincter), creating it tougher for your anal fissure to heal. AN ill  fissure will trigger a cycle of discomfort which will need medications or surgery to scale back the pain and to repair or take away the fissure. 

Prevention Anal fissure

You may be able to prevent associate anal fissure by taking measures to forestall constipation or diarrhea. Eat high-fiber foods, drink fluids and exercise often to stay from having to strain throughout gut movements.

What happens if a fissure goes untreated?

When you are suffering from a fissure your symptoms will vary depending on the size of the fissure and how long it has been there If left untreated however a fissure can grow more severe over time and may lead to other complications Take action as soon as possible by using an effective hemorrhoid treatment product that treats the underlying cause of hemorrhoids while soothing your symptoms such as pain itching and burning.

Is Vaseline good for fissures?

Vaseline has been a staple in the medicine cabinet for over 125 years It was invented to help prevent chapped lips and skin but it turns out that it’s also great for other types of skin ailments One of the most common uses is as an ointment to help heal fissures (small openings) in your anus By applying vaseline a couple times a day you can help reduce pain itching and discomfort associated with fissures.

Does a heating pad help fissures?

Fissures are painful open sores in the lining of your anus Fissures develop when you strain to pass stool and small tears occur on the surface of your anus A fissure can be caused by several things including constipation diarrhea trauma or childbirth Treating a fissure depends on its cause -- preventing constipation may help prevent future fissures while surgery might be needed if it is caused by a surgical procedure such as childbirth If you suffer from chronic anal pain that lasts for more than three weeks see your doctor for an evaluation If the pain does not subside with.

Is it a hemorrhoid or fissure?

Most people confuse these two ailments and assume they are the same thing but they are not The only characteristic that is shared between the two is intense pain during a bowel movement Because of this intensity both constipation and diarrhea can be painful Constipation occurs when there is difficulty with forceful bowels and may cause rectal pressure or discomfort A fissure on the other hand is a small tear in the anal canal which causes intense pain when trying to have a bowel movement and bleeding afterwards Hemorrhoids are swollen veins around the anus area due to straining to move stool and are generally not as painful as.

How can you tell the difference between piles and fissures?

Piles are usually more shallow than fissures and produce bleeding on the surface of the stool Fissures occur deeper in the rectal tissue and internal bleeding produces blood in the stool However this is not always true Patients can have a pile with significant internal bleeding that does not produce any visible blood in the stool In these patients they may notice pain while having a bowel movement or during passage of gas or stool The location of the tumor determines if it has spread to other organs such as liver kidney and lung If an individual is experiencing abdominal pain without evidence of piles or fissures then he.

Diagnosis Anal fissure

Anal fissure is the leading cause of anal pain. This common, benign condition causes severe pain that can be recurrent and disabling.

The diagnosis is most often apparent when it is seen in person, but it can be difficult to determine because people may feel uncomfortable during the examination and the pain may be intense.

The essential crack must be distinguished from specific fissures: Cancer Infection.

A complementary examination is not helpful in determining the cause of a lesion. A histology is necessary to determine the cause of a lesion if it is atypical: there are no pain symptoms near the crack, or the lesion is located farther up the spinal cord than usual.

Medical treatment is usually the first thing recommended.

Surgery is the treatment of last resort. Its main disadvantage is the risk of incontinence. 

Your doctor can possibly raise your case history and perform a physical examination, together with a delicate examination of the anal region. Typically the tear is visible. Sometimes this exam is all that's required to diagnose an anal fissure. Associate degree acute anal fissure feels like a contemporary tear, somewhat sort of a paper cut. A chronic anal fissure likely contains a deeper tear, and will have internal or external fleshy growths. A fissure is taken into account if it lasts over eight weeks. The fissure' location offers clues about its cause. A fissure that happens on the facet of the anal opening, instead of the rear or front, is a lot of possible to be a signal of another disorder, admire Crohn' disease. Your doctor could advocate more testing if he or she thinks you have got an underlying condition:

  • Anoscopy. An anoscope is a tubular device inserted into the anus to help your doctor visualize the rectum and anus.

  • Flexible sigmoidoscopy. Your doctor can insert a thin, versatile tube with a small video into the all-time low portion of your colon. This check could also be done if you're younger than fifty and don't have any risk factors for internal diseases or colon cancer. 

  • Colonoscopy. Your doctor can insert a versatile tube into your body part to examine the complete colon. This check could also be done if you're older than age fifty otherwise you have risk factors for colon cancer, signs of alternative conditions, or other symptoms adore abdominal pain or diarrhea. 

Treatment Anal fissure

Although most ANal fissures don't need surgery, chronic fissures are more durable to treat and surgery could also be the simplest option. The goal of surgery is to assist the sphincter and muscles relax that reduces pain and spasms, permitting the fissure to heal. Surgical choices embrace neurolysin (Botox®) injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Your colon and body part physician can realize the best treatment for you and discuss the risks of surgery. Each form of surgery is generally done as same-day patient procedures. Anal fissures typically heal inside many weeks if you're taking steps to stay your stool soft, appreciate increasing your intake of fiber and fluids. Soaking in heat water for ten to twenty minutes many times a day, particularly once intestine movements, will facilitate relaxation of the musculus and promote healing. If your symptoms persist, you'll doubtless want more treatment.

Nonsurgical treatments

Your doctor may recommend:

  • Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to assist relax the anal sphincter. vasodilative is mostly thought-about the medical treatment of alternative once alternative conservative measures fail. facet effects may embrace headache, which might be severe. 

  • Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief.

  • Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms.

  • Blood pressure medications, such as oral Procardia (Procardia) or Cardizem (Cardizem) will facilitate relaxation of the anal sphincter. These medications are also taken orally or applied outwardly and should be used once Nitrospan isn't effective or causes important facet effects. 


  • The goal of the treatment is to cure the symptoms permanently and without further complications. In a long catalog alone traditional medical treatments and nitrated derivatives have been found to achieve this objective. Traditional treatment seeks to address the traumatic component by avoiding the passage of hard stools or defecation efforts. This way, it struggles against constipation and pain. If necessary, he may resort to a laxative. There are a number of hygiene and dietary tips that are usually recommended, but there are some exceptions. For example, laxatives can help some people with this problem. Suppositories that use local anesthetics help those who cannot take pills or injections. Hydrocortisone is typically used without evidence. This conservative approach allows for a healing rate of 45%. The main cause of initial failure seems to be poor compliance. The fight against pain also participates in this process. The relief of the painful spasm (an anti-inflammatory non-steroidal medication). The nitrated derivatives work on the Sphincterian component of the crack by inducing a relaxation of the internal sphincter, which will improve the situation. A local application of ano-dermal blood infusion has been shown to be very promising in studies against placebo. In 68% of cases, compared to 8% with placebo, the treatment was found to be more effective. A lot of people don't follow the rules because they get headaches or irritation on their skin. This eventually causes them to become tired and frustrated. There is no benefit to continuing the treatment beyond 40 days. The safety of the product and a high healing rate (between 30 and 80%) often make frontline treatment the best option. There is no scientific evidence to support the use of alternative medicine over traditional methods like surgery.
  • Instrumental injection of medicine with 5% kinine-urea kinine is poorly practiced and can lead to infection in areas that have cracks because of age.
  • If you've got a chronic anal fissure that's proof against alternative treatments, or if your symptoms are severe, your doctor might suggest surgery. Doctors sometimes perform a procedure known as lateral internal sphincterotomy (LIS), that involves cutting atiny low portion of the sphincter ani muscle to cut back spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is way simpler than any medical treatment. However, surgery encompasses a small risk of inflicting incontinence.
  • Surgery is still the most effective treatment even if research neglects the simple forms of healing that spontaneously or after a brief treatment. This is the only one that can effectively process the appendices of a crack. There is no longer a need for dilation. The most studied method, internal lateral sphincterotomy (SLI), is considered the reference technique in the world. The goal is to address hypertonia by only a part of the internal sphincter. This will heal the crack secondary to this action alone. The section should be partial in height and thickness .The main effect of this should be pretty significant. Secondary is the occurrence of continent disorders in varying proportions (0 to 375%) according to their seniority and type of incontinence. Most often it is a mere incontinence in cases of emergency gas, but it can also be more serious conditions like continent urinary incontinence. SLI is difficult to recommend even if it is proposed quickly after failure of conventional treatment . The goal of fissurectomy is to remove the fissuraire fabric. A fissurectomy is well-suited to treating chronic cracks that have a lower share of sphincter hypertonia--a condition in which the sphincters are too tense. The main benefit would be a slight risk of sphincter dysfunction, as well as the ability to treat the crack more effectively. The histology test will determine if the pulp in the grape is not ripe enough and will result in the removal of the ancillary tissue, such as papillary hypertrophy and sentinel grapes. A fissurectomy can then be performed. A cover plasty (a surgery that repairs a split in the skin) is better than an internal side sphincterotomy for controlling pain. However, it is not as good as a fissurectomy (a surgery that removes a split in the skin) alone. Novo  incontinence is treated with a fissurectomy (a surgical removal of the lining of the bladder) - an operation that is identical in speed and healing rate to a simple but faster surgery that does not involve a flap. This passage has a difference of thirteen letter points. 

Lifestyle and home remedies

Several fashion changes might facilitate relieve discomfort associated promote healing of an anal fissure, also as stop recurrences:

  • Add fiber to your diet. Eating twenty five to thirty grams of fiber every day will facilitate keeping stools soft and improve fissure healing. Fiber-rich foods embrace fruits, vegetables, nuts and whole grains. you furthermore might take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. 

  • Drink adequate fluids. Fluids help prevent constipation.

  • Avoid straining during bowel movements. Straining creates pressure, which may open a healing tear or cause a replacement tear. If your baby has an anal fissure, make certain to vary diapers frequently, wash the world gently and discuss the matter together with your child' doctor. 

Preparing for your appointment

If you've got Associate in Nursing anal fissure, you'll be stated as a doctor who focuses on organic process diseases (gastroenterologist) or a colon and body part surgeon. Here's some data to assist you make preparations for your appointment.

What you can do

When you build the appointment, raise if there's something you wish to try and do in advance, cherish fast before having a particular test. build an inventory of:

  • Your symptoms, even if they may seem unrelated to the reason for your appointment.

  • Key personal information, including major stresses, recent life changes and family medical history.

  • All medications, vitamins or other supplements you take, including the doses.

  • Bring someone with you. If possible, bring a family member or friend with you to help remember things you may forget.

  • Prepare questions to ask your doctor.

Some basic questions to ask your doctor include:

  • What is likely causing my symptoms?

  • Are there any other possible causes for my symptoms?

  • Do I need any tests?

  • Is my condition likely temporary (acute) or chronic?

  • Are there any dietary suggestions I should follow?

  • Are there restrictions I need to follow?

  • What's the best course of action?

  • What are the alternatives to the primary approach you're suggesting?

  • I have these other health conditions. How can I best manage them together?

  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor may ask:

  • When did you begin experiencing symptoms?

  • Have your symptoms been continuous or occasional?

  • How severe are your symptoms?

  • Where do you feel your symptoms the most?

  • Does anything seem to improve your symptoms?

  • What, if anything, seems to worsen your symptoms?

  • Do you have any other medical conditions, such as Crohn's disease?

  • Do you have problems with constipation?

What you can do in the meantime

While you're waiting to see your doctor, take steps to avoid constipation, such as drinking plenty of water, adding fiber to your diet and exercising regularly. Also, avoid straining during bowel movements. The extra pressure may lengthen the fissure or create a new one.

General summary

  1. Anal fissures are tears in the lining of the anus. They can cause pain, bleeding, and a burning sensation during bowel movements. The cause of anal fissures is typically due to straining during a bowel movement, or due to a lack of lubrication and poor hygiene. Treatment may include dietary changes, topical medications, and in some cases, surgery.

  2. An anal fissure is a tear in the lining of the anus that can cause sharp pain and bright red bleeding during bowel movements. It is usually caused by passing a large or hard stool and can be made worse by chronic constipation or diarrhea. Without proper treatment, an anal fissure can persist for weeks or months. Treatment options range from lifestyle changes to topical ointments and medications to surgery, depending on the severity of the fissure.

  3. An anal fissure is a tear or crack in the lining of the anus, which can cause pain and bleeding. The discomfort may be especially intense after a bowel movement. It is often caused by the passage of hard or large stools. In many cases, it can be treated with simple home remedies and lifestyle modifications, though it may require medical attention in more serious cases.

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