Anal Fissures: Causes, Symptoms, and Home Remedies That Work

What Are Anal Fissures?

Anal fissures are small tears in the thin, moist tissue (mucosa) lining the anal canal—the last section of the digestive tract, just before the anus. These fissures are often caused by the trauma of passing large, hard stools, though other factors can contribute. When this delicate tissue is stretched beyond its capacity or subjected to trauma, it can tear, exposing the underlying muscle. The exposed muscle often goes into spasm, pulling the edges of the wound apart and impairing blood flow, which delays healing. Anal fissures are classified as acute if they have been present for less than 6 weeks or chronic if they persist beyond 6 weeks. Chronic fissures are more challenging to treat and often require medical intervention.

Causes of Anal Fissures

Several factors can contribute to the development of anal fissures:

• Passing large, hard stools due to constipation
• Chronic diarrhea or frequent loose stools
• Straining during bowel movements
• Trauma from anal intercourse or the insertion of foreign objects
• Childbirth, especially vaginal delivery with prolonged or difficult labor

Less common anal fissure causes include inflammatory bowel diseases like Crohn's disease, decreased blood flow to the anal region, and excessive tension in the anal sphincter muscles. The repeated injury from passing stool and the subsequent muscle spasms can prevent the fissure from healing, leading to a chronic condition.

Symptoms of Anal Fissures

The hallmark symptoms of anal fissures include:

• Severe, sharp pain during and after bowel movements, often lasting for several minutes to hours
• Bright red blood on the stool or toilet paper
• Visible crack or tear in the skin around the anus
• A small lump or skin tag near the fissure
• Burning or itching sensation in the anal area
• Constipation or pain with straining due to fear of painful bowel movements

These anal fissure symptoms can be distressing and may cause anxiety about using the restroom. If you experience persistent anal pain and bleeding, it's essential to consult a doctor for an accurate diagnosis and appropriate treatment.

Diagnosis: How Are Anal Fissures Identified?

Anal fissure diagnosis typically involves a physical examination of the anal region. Your doctor will:

• Visually inspect the anus for cracks, tears, or skin tags, often by gently separating the buttocks
• Perform a digital rectal exam, if tolerable, to assess sphincter muscle tone and check for masses or other abnormalities
• Use an anoscope, a small tubular instrument, to closely examine the anal canal for fissures that may not be visible externally. This procedure is generally done gently to minimize discomfort

In some cases, additional tests may be necessary:

• Sigmoidoscopy or colonoscopy to evaluate the lower colon and rule out other conditions like inflammatory bowel disease or colorectal cancer
• A biopsy of the fissure edges, if atypical features are present, to exclude other diagnoses like anal cancer or sexually transmitted infections

An accurate diagnosis is crucial to differentiate anal fissures from other conditions causing similar symptoms, such as haemorrhoids, anal abscess, or anal fistula, and guide appropriate treatment.

Possible Complications of Anal Fissures

While most anal fissures heal within a few weeks, some may persist and lead to complications:

• Chronic fissures that do not heal despite conservative treatment
• Development of skin tags or sentinel piles, which are small lumps of skin near the fissure that can cause discomfort
• Infection or abscess formation in the anal area
• Formation of fistulas, abnormal tunnels connecting the anal canal to the skin, in very rare cases, typically when infection or abscess occurs
• Increased muscle spasms can worsen pain, delay healing, and may contribute to the development of chronic fissures
• Psychological distress due to chronic pain and fear of bowel movements

Prompt anal fissure diagnosis and treatment can help prevent these complications and promote faster healing.

Treatment Options for Anal Fissures

Treatment for anal fissures depends on whether they are acute or chronic. The goals of treatment are to relieve pain, promote healing, and prevent recurrence.

Conservative measures are often effective for acute fissures:

• Increasing fiber intake and staying hydrated to soften stools and prevent constipation
• Using over-the-counter stool softeners or fiber supplements as needed
• Taking warm sitz baths several times a day to relax the anal sphincter and improve blood flow
• Applying topical anesthetics or numbing creams to ease pain during bowel movements

If conservative treatment fails or for chronic fissures, medical options include:

• Topical nitroglycerin ointment or calcium channel blockers to relax the anal sphincter and improve blood flow
• Botulinum toxin (Botox) injections into the anal sphincter to relax the muscle and promote healing
• Oral medications are not typically used for fissures; topical calcium channel blockers like nifedipine or diltiazem are preferred to relax the anal sphincter

Surgical treatment, such as lateral internal sphincterotomy (LIS), may be considered for chronic fissures not responding to medical therapy. LIS involves cutting a portion of the internal anal sphincter to relax the muscle and allow the fissure to heal. It has a high success rate but may rarely cause temporary or permanent incontinence.

Prevention of Anal Fissures

Preventing anal fissures involves maintaining healthy bowel habits and avoiding constipation:

• Eat a high-fiber diet rich in fruits, vegetables, and whole grains
• Drink plenty of water and stay hydrated
• Exercise regularly to promote regular bowel movements
• Don't ignore the urge to have a bowel movement
• Use the restroom promptly when you feel the urge to avoid constipation or straining
• Avoid straining or spending excessive time on the toilet
• Keep the anal area clean and dry
• Use gentle cleaning techniques and avoid irritating soaps or wipes
• Manage any underlying medical conditions that may contribute to constipation or diarrhoea.

By adopting these lifestyle measures, you can reduce your risk of developing anal fissures or prevent recurrences after treatment.

Home Remedies and Lifestyle Tips

In addition to medical treatment, several home remedies can help manage anal fissure symptoms and promote healing:

• Soak in a warm sitz bath for 10-15 minutes, 2-3 times daily, to soothe the anal area and relax the muscles
• Use stool softeners or mild laxatives as needed to avoid hard stools
• Increase your intake of fiber-rich foods like fruits, vegetables, and whole grains
• Drink at least 8-10 glasses of water daily to keep stools soft
• Avoid harsh wiping after bowel movements; use moist wipes or cotton balls instead
• Apply over-the-counter topical creams or anal fissure ointment containing lidocaine or hydrocortisone for temporary pain relief
• Practice relaxation techniques like deep breathing or meditation to reduce muscle tension and anxiety during bowel movements

Remember, while home remedies can be helpful, it's essential to consult your doctor if symptoms persist or worsen.

Chronic vs Acute Anal Fissures

Understanding the differences between acute and chronic anal fissures is important for determining the appropriate course of treatment.

Chronic fissures are more challenging to treat due to ongoing muscle spasms, scarring, and impaired blood flow, making it harder for the wound to heal. Working closely with a doctor can help ensure the best outcome.

Conclusion: When to See a Doctor for Anal Fissures

Many anal fissures heal with home care, but seek medical help if symptoms last more than one to two weeks despite treatment. Also, consult a doctor if you have severe pain affecting daily activities, noticeable bleeding or bloody stools, or a visible lump near the anus. If you develop a fever or signs of infection, prompt medical attention is important. A doctor can diagnose the cause of your symptoms and suggest the best treatment to promote healing and prevent complications.

At Metropolis Healthcare, we offer comprehensive diagnostic services, including blood tests and stool analysis, to help identify any underlying health issues that may contribute to anal fissures. Our team of experienced phlebotomists can perform convenient at-home sample collection, ensuring your comfort and privacy. With accurate test results and personalised care, we empower you to take control of your health and find lasting relief from anal fissures.

FAQs

Are anal fissures common?

Yes, anal fissures are a common condition, affecting people of all ages. They are particularly prevalent in infants and young children, as well as adults who experience constipation or frequent straining during bowel movements.

What does an anal fissure feel like?

An anal fissure typically causes sharp, severe pain during and after bowel movements. You may also experience burning, itching, or throbbing sensations in the anal area, along with visible bleeding on the stool or toilet paper.

How do I know if I have a haemorrhoid or an anal fissure?

While both conditions can cause anal pain and bleeding, haemorrhoids usually appear as swollen veins around the anus, while fissures are visible cracks or tears in the anal lining.

Also Read: Relief from Hemorrhoids: Symptoms, Causes, and Effective Treatement

Do anal fissures heal on their own?

Most acute anal fissures heal within 4-6 weeks with conservative measures like increasing fibre intake, staying hydrated, and taking warm sitz baths.

How long do anal fissures usually last?

Acute fissures typically heal within 6 weeks, while chronic fissures may persist for several months or longer without proper treatment.

How do you heal an anal fissure at home?

Home remedies for anal fissures include increasing fibre intake, staying hydrated, taking warm sitz baths, using topical creams, and practising good anal hygiene.

Should I adjust my diet while living with an anal fissure?

Yes, increasing your intake of fibre-rich foods and drinking plenty of water can help soften stools and promote healing of the fissure.

Why do I keep getting anal fissures?

Recurring anal fissures may be due to chronic constipation, diarrhoea, or an underlying condition like inflammatory bowel disease. Consult your doctor to identify the cause.

What happens if a fissure is not treated?

Untreated fissures can become chronic, leading to complications like persistent pain, skin tags, infections, or fistulas.

Is fissure surgery painful?

While some discomfort is expected after anal fissure surgery, the pain is usually manageable with medication and subsides within a few days to weeks.