What is Anal Fissure?
An anal fissure is a tiny tear or cut in the anus lining. During and after bowel motions, the skin crack causes intense pain and some bright red bleeding. Sometimes, the fissure may be deep enough to reveal the muscle beneath.
Stool softeners and topical painkillers are two therapies that can aid in healing and ease discomfort.The tear typically heals by itself. When the fissure lasts longer than six weeks, it is regarded as chronic.
If an anal fissure doesn’t heal after receiving these treatments, you might require surgery. Or else, your doctor would need to check for further underlying conditions that can result in anal fissures.
Symptoms of Anal Fissure
Anal fissure warning signs and symptoms include:
- Pain with a bowel movement and for several hours afterwards
- Observing blood on the surface of the stool.
- blood on bathroom paper or wipes
- a clear fissure or tear in the anal canal or anus
- Irritation and burning that could be hurtful
- urinary discomfort, frequent urination, or difficulties urinating
- foul smelling discharge
Therefore, if you experience any of these symptoms, seek medical consultation from Dr. Pradeep Tripathi before assuming fissures are to blame.
Causes of Anal Fissure
The lining of the anus or anal canal, the final section of the large intestine, is most frequently the source of anal fissures.
The majority of cases happen in constipated patients when a particularly large or hard poop breaks the lining of the anal canal.
Anus and anal canal injuries can result in anal fissures. One or more of the following factors may contribute to the trauma:
- Prolonged Constipation that lasts a long time
- chronic diarrhea
- Anal stretching and anal sex
- foreign things being inserted into the anus
Other causes apart from trauma include:
- Chronically bad bowel habits
- Spastic or too tight anal sphincter muscles (muscles that control the closing of the anus)
- Angular anorectal scarring
- An underlying medical condition, such as inflammatory bowel disorders like Crohn’s disease and ulcerative colitis, leukemia, anal cancer, infectious diseases like tuberculosis, and sexually transmitted infections (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
- Reduced blood flowing to the anorectal region
Anal fissures are also typical in newborns and in women who have just given birth.
Treatments for Anal Fissure
Anal fissure treatment seeks to reduce pressure on the anal canal by softening stools, as well as to relieve pain and bleeding.
Conservative therapies, which may involve one or more of the following, are first tried:
- By using stool softeners to prevent constipation, increasing fluid consumption while avoiding caffeine-containing items (which might dehydrate you), and making dietary changes (eating more high-fiber meals and fibre supplements)
- Soaking in a warm bath for 10 to 20 minutes many times a day to assist the anal muscles relax
- Softer cleansing of the anorectal region
- Avoid squeezing or spending too much time on the toilet
- Using oil or petroleum jelly to help lubricate the anorectal region.
Surgeries to Treat Anal Fissure
If you have a chronic anal fissure that is unresponsive to other therapies or if your symptoms are severe, your doctor may recommend surgery.
In order to reduce spasm, pain, and promote healing, doctors frequently conduct a technique known as lateral internal sphincterotomy (LIS), which involves severing a small piece of the anal sphincter muscle.
According to studies, surgery is by far the most effective treatment option for chronic fissures. Surgery does, however, have a minor risk of resulting in incontinence.
Anal fissures can be treated surgically using a variety of different methods.
A lateral sphincterotomy is making a little cut in the ring of muscle surrounding the sphincter in order to lessen the stress in your anal canal. This provides relief of the anal fissure and lowers your risk of getting any further fissures.
It is a short, very simple procedure that is typically done as a day patient under a general anesthesia. Since you’ll be asleep during the surgery, you won’t often need to spend the night in the hospital.
One of the most successful therapies for anal fissures is a lateral sphincterotomy, which has a solid track record of success. Most people will recover completely in two to four weeks.
Advancement Anal Flap
Advancement anal flaps involve healing the fissure with healthy tissue taken from another area of your body and enhancing the blood flow to the fissure spot.
This procedure may be suggested for the treatment of long-lasting (chronic) anal fissures caused on by pregnancy or an anal canal injury.
The steps in an advancement flap procedure can be summed up as follows:
- Elevating a flap, coring out an infected gland and an epithelized internal opening, suturing the internal sphincter defect, closing the wound with a flap, and ensuring efficient drainage.
- A dermal island or cutaneous flap has lately been utilized for the same reason, however historically a mucosal flap has been.
These techniques may be more advantageous from a technical perspective than a mucosal advancement flap because they can provide for simpler operation access. Additionally, they reduce mucosal ectropion and drainage.
To diagnose your fissure treatment and for further details, see our expert consultant Dr. Pradeep Tripathi.
Preventative Measures for Anal Fissure
If you already have an anal fissure, take these easy precautions to prevent obtaining another one.
- Eat a lot of fibre – An anal fissure might develop if you have constipation and pass large, hard, or dry stools. Constipation can be avoided, though, by include lots of fibre in your diet, particularly from fruits and vegetables.Every day, consume 20 to 35 grams of fibre.
Among the foods that are good sources include:
- Citrus fruits
- Wheat bran
- Oat bran
- Whole grains, including brown rice, oatmeal, popcorn, and whole-grain pastas, cereals, and breads
- Peas and beans
- Seeds and nuts
- Prunes fruit and juices
If your diet isn’t providing you with enough fibre, consider taking supplements. Increase your consumption gradually until you notice softer, more frequent bowel motions, whether you eat more fiber-rich foods or use supplements.
Additionally, hydrate yourself well when you consume more fibre. You can avoid bloating and gas by doing this.
- Stay hydrated – That may be able to assist you avoid constipation. Adding fluid to your system through frequent hydration might help to soften and ease the passage of stools. When the weather grows warmer or as you start to exercise more, make sure to drink more.
Not all beverages are recommended for hydration. Alcoholism can cause dehydration. Additionally, even though a caffeinated beverage may aid in urination, consuming too much caffeine can cause you to become dehydrated.
- Exercise – Lack of exercise is one of the most frequent reasons of constipation. To maintain your digestive system healthy and moving, exercise for at least 30 minutes most days.
- Don’t avoid the urge to go to toilet – Don’t wait until later if your body signals that a bowel movement is necessary. The signals that tell you when it’s time to leave can become weakened if you wait too long or too frequently. It can become dryer and harder the longer you hold it in, making it harder to pass.
- Maintain healthy bowel habits – Constipation and anal canal stress can be reduced with the help of these suggestions. To decrease your chance of developing an uncomfortable anal fissure, evaluate these habits frequently:
- Give yourself ample time to easily perform bowel movements when using the restroom. However, avoid staying too long on the toilet.
- While passing stools, avoid straining.
- Dry off the anal region.
- Cleanse yourself gently after every bowel movement.
- Use toilet paper or wipes that are soft, unscented, and free of dye.
Keep up with your therapy if you have other disorders, such as Crohn’s disease or IBS that can cause anal fissures.
- Consult your physician about laxatives – Laxatives may be helpful if increasing your dietary fibre intake and taking fibre supplements are insufficient to relieve constipation. Some operate in various ways.
Bulk-forming laxatives, often known as fibre supplements, are thought to be the safest type of laxative. They enlarge your stools by enabling them to absorb and hold liquids.
Additionally, they promote colonic contractions that help move stools along. Calcium polycarbophil, methylcellulose, psyllium, or wheat dextrin are examples of laxatives that cause bulking up. They are consumed with water.
Different kinds of laxatives can assist by:
- Increasing the water content of the intestines
- Lubricating stools to enhance their movement (mineral oil)
- Drawing water or pulled into the colon
- Quickening bowel movements by stimulating the intestine’s muscles
Anal fissures can also develop in infants. Infants should get frequent diaper changes.
If your infant exhibits any constipation symptoms, change their diaper frequently and seek medical attention.
Sharp discomfort and small amounts of bright red blood with bowel movements can be caused on by anal fissures.
The most common cause of anal fissures is long-term or recurrent damage to the area. Anal fissures are frequently caused by childbirth, anal intercourse, and passing of hard stools.
Previous anal surgeries, inflammatory bowel illness, local malignancies or cancers, and sexually transmitted infections are a few more disorders connected to anal fissures.
Anal fissures may typically be treated at home with excellent wound cleanliness and prevented from recurring with minor food and lifestyle modifications.
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