Anal Fissure



Hemorrhoids and fissures occur in the rectum when the anal tissues are damaged by chronic constipation and over straining. A hemorrhoid is a bunch of inflamed varicose veins in the inner layer of the rectum and anus. You should look out for an extended area of skin just beyond the anus if afflicted with an external hemorrhoid. These are dilated veins that gradually stretch over repeated straining and get pushed outwards towards the anus. You can treat external hemorrhoids with oral medicines and ointments to be applied locally. Internal hemorrhoids are more painful and they occur at the juncture of the rectum and anus inside the body. They are covered with mucous membrane and may jut out of the anus cutting off the blood supply.

Small tears in the mucus lining of the anal cavity create anal fissures. Constipation can tear the membranes in the inner walls of the rectum; with symptoms like blood with stools or blood on the toilet paper as first indications of the internal damage. While fissures heal by themselves over time, they can be extremely painful, especially while passing stool. Some easy procedures to speed up the healing would be to use medications that have analgesics, steroids and ointments with nitroglycerin to relax the muscle lining beneath the damaged mucus layer in the anus. In severe cases, the fissure can be removed surgically through a procedure known as ‘lateral internal sphincterotomy.’

 

Symptoms of Anal Fissure

You should consult a doctor if you have the following fissure symptoms:

  • You experience an intense, severe, prickly pain in and around your anus that stays on for hours after passing stools.
  • You see drops of blood coming out while you pass a stool or in your toilet paper.
  • Check out for the kind of blood that comes out. There should be blood only in the side or outer lining of your stool. This is different from blood mixed with stools, which are symptoms of inflammatory bowel diseases and other serious conditions.
  • You will find a tag of skin, known as sentinel pile, developing below the fissure, mostly at the edge of the anus.
  • The symptoms above can sometimes be accompanied by a smelly discharge and itching in the anus.
 

Causes of Anal Fissure

There are several causes of fissures, and you may get them due to any of the following reasons:

  • The most common cause of an anal fissure is constipation. In this condition, the anal lining tears and the sphincter muscles get damaged with over straining to pass out a hard and dry stool.
  • Applying higher than normal pressure in the anal sphincters, spending a long time sitting during your bowel movements (example sitting in the pot and reading a magazine or newspaper, etc) also increases pressure on muscles, and with time, they weaken and tear with the slightest of over straining.
  • Chronic diarrhea, where you have to pass stool at very short intervals, several times in a day adds pressure on the sphincter muscles and can cause fissures.
  • Inflammation of the anorectal area will also cause anal fissures.
  • Infection in the skin around the anus makes the skin susceptible to wear and tear and can cause anal fissures. This condition is prevalent in almost all sexually transmitted diseases like syphilis.
  • Many women develop fissures during the final semester of their pregnancy or during childbirth. This is because there is increased pressure on the sphincter muscles with the increased weight during pregnancy and because of the straining required to push the baby out during delivery.
  • Insertions made through the anus during certain examinations, like rectal thermometer, endoscope, ultrasound probe or enema tip can damage the tissues in the anus.
  • Anal intercourse leads to straining and can cause fissures.
  • Patients suffering from a suppressed immune system and the human immunodeficiency virus or the HIV infection are prone to fissures
  • People suffering from certain health conditions like diabetes, vitamin B-6 deficiency, fever, Crohn’s disease, inflammatory bowel movements that cause diarrhea with blood are more likely to suffer from anal fissures.
  • Tuberculosis and anal cancer can also be causes for anal fissures.
  • Certain medicines like nicorandil can cause damage to the anus.
 

Remedies for Anal Fissure

Simple anal fissures usually take four to six weeks to cure. These can be cured naturally by following some simple home remedies. However, it is best to consult a doctor and depending on the severity of your situation, have him prescribe them to you. Some of the common home remedies for fissures include the following:

  • The most important prerequisite to healing is to minimize pressure on the anus while passing stools and manage the pain during and after bowel movements. You can do by making dietary changes that enable easier passage of stools. Avoid chilies, and hard to digest foods.
  • Stay hydrated by including lots of fluids and roughage to your diet.
  • Apply coconut oil, aloe compresses and wheat germ oil to the affected areas to speed up curing. These natural home products have antiseptic and healing qualities.
  • Sitting in warm water for about twenty minutes, three times a day, can provide considerable relief. This is known as known as sitz bath. The warmth of the water will minimize chances of infection and improve blood circulation. This will help in muscle recovery and healing.
  • It is best to keep the area dry to avoid infection and other discomforts like itching and burning. You can dab a little baby powder after a shower, but avoid cosmetics that are scented or harsh on the skin.
  • Cleaning the anus with soft facial tissues is better than using normal toilet paper. This will minimize irritation to the sore tissues.
  • Cleaning the area a couple of times in a day with an infusion of chamomile and witch hazel will help the blood vessels to shrink and heal quickly.
  • Calendula balm also helps reduce pain and itchiness. Creams containing vitamin A and D can also be applied to the anus, but you must consult your doctor to find out what compositions will work best for you.

Treatment for fissure will be required especially if they do not heal in six weeks time. Fissures can be cured through certain preventive measures and medications:

  • Your physician can prescribe a local anaesthetic like Lidocaine cream, ointment or suppositories to stop the pain in the anus.
  • Nitroglycerin cream with a composition of about 0.2% allows the fissure to heal by reducing the pressure in the sphincter. This cream should be used in small quantities since it has side effects like fainting from low pressure, headaches and lightheadedness.
  • Glyceryl trinitrate is a rectal ointment that improve blood flow to the anus, relaxes the internal anal sphincter muscles, reduces the spasms and helps the fissure heal quickly.
  • Botox or Botulinum toxin causes momentary numbness of the muscles. This is great for reducing muscle tension and helping the anal fissure to heal. You need to get the Botox injected in the internal anal sphincter.
  • Nifedipine and Diltiazem also reduce pressure on internal anal sphincter by blocking calcium. These are called calcium blockers and are available as gel ointments as well as oral medicines.
  • You may have to use a surgical procedure to remove the fissure if the medications fail to improve your condition. It is called lateral internal sphincterotomy (LIS), and entails a small cut in the internal sphincter muscle to relieve the pressure within your anus and stop it from going into spasm.
 

Diet for Anal Fissure

Your bowel movements will depend on the food you eat. Make sure you follow a healthy balanced diet to avoid constipation, soften stools and regularize your bowel movements. This is one condition where your diet has a direct effect on your outcome, so make sure you focus your efforts on dietary modifications. This will make the painful process of passing stools with the fissure easier and speed up the healing process by avoiding further wear and tear.

  • Include high fiber foods in your diet every day. Fruits, vegetables, beans and whole grains are good choices. This will soften your stool, make bowel movements easier and minimize straining of the damaged muscles.
  • Avoid spicy food and those that are hard to digest as these would cause further irritation and difficulty in the passage of stools. Examples include chilly peppers, popcorn, chilly seeds etc.
  • Dehydration can also cause a hardening of stools, so keep drinking lots of water, juices and other fluids throughout the day. Ideally you should drink at least eight to ten glasses of water in a day. The color of your urine can be indicative of dehydration; under normal circumstances it should be clear like water or light yellow in colour.
  • You can ask your doctor to prescribe a fiber supplement everyday if you think your body needs it.

Suggestions for Anal Fissure

It helps to get some exercise every day. You should do some moderate exercises for about two and a half hours a week. If you indulge in rigorous exercises, an hour and a half of exercises in a week is usually sufficient.

To get relief from the tissue inflammation, you can sit in a tub of warm water for about half an hour. Repeat this twice or thrice a day. This process will help the internal anal sphincter muscles to relax and heal.

References

  1. Nelson RL, Thomas K, Morgan J, Jones A (2012). "Non surgical therapy for anal fissure". Cochrane Database Syst Rev 2: CD003431.

 
Anal Fissure - Frequently asked questions