Anal fissure: Difference between revisions

Revision as of 04:57, 19 March 2025

Anal fissure, also known as fissura ani, is a small tear in the anal canal, typically causing pain and discomfort during and after defecation. The condition often leads to rectal bleeding, particularly after bowel movements. The sharp, intense pain may last for minutes to hours, making defecation a distressing experience.

Causes

The exact cause of an anal fissure is not always clear, but several factors contribute to its development:

Constipation and straining during bowel movement
Excessive tension in the anal sphincter
Reduced blood circulation to the anal region
Skin irritation due to improper drying after bathing or swimming
Excessive stretching of the anal canal
Pregnancy and childbirth
Delayed diaper changes in infants

Once a fissure occurs, it may take 6 weeks to 3 months to fully heal. During this period, the fissure can reopen easily, leading to recurring symptoms.

Treatment

Management of anal fissures involves a combination of medications, lifestyle changes, and, in some cases, surgery. Treatment options include:

Medications

A healthcare provider may prescribe various treatments to relieve pain, reduce inflammation, and promote healing:

Topical pain-relief ointments – Medications containing local anesthetics can help reduce pain and discomfort.
Suppositories – Rectal medications that provide relief by coating and soothing the affected area.
Laxatives – To prevent constipation and ease stool passage.
Zinc-based ointments – Help protect and contract the skin, promoting faster healing.
Muscle relaxants – Medications such as nitroglycerin or calcium channel blockers may help relax the anal sphincter and improve blood flow.

Home Remedies and Self-Care

Patients can adopt several measures to promote healing and prevent recurrence:

Eating a high-fiber diet, including whole grains, vegetables, and fruits.
Staying hydrated by drinking plenty of fluids.
Using a stool softener if necessary.
Practicing proper hygiene and ensuring the anal area remains dry.
Taking warm sitz baths 2–3 times daily to relax the anal muscles and promote healing.

Chronic Fissure Treatment

If an anal fissure persists for more than 6 weeks, it is classified as chronic. Treatment options for chronic fissures include:

Botulinum toxin (Botox) injection – Helps relax the anal sphincter, reducing pressure and promoting healing.
Lateral internal sphincterotomy – A surgical procedure where a small portion of the anal sphincter is cut to reduce tension and improve healing.
Dilation procedures – Involves gentle stretching of the anal canal to reduce pressure.

Prevention

To prevent recurrence, patients should take certain precautions for up to three months after healing. Recommended steps include:

Dietary and Lifestyle Changes

Maintain a high-fiber diet to prevent constipation.
Avoid foods that can harden stool, such as white bread, cheese, and caffeine.
Drink enough water daily to keep bowel movements soft.
Engage in regular physical activity to promote healthy digestion.

Proper Hygiene Practices

Ensure the anal area is completely dry after bathing or swimming.
Use soft toilet paper or baby wipes instead of rough tissues.
Wash the anal region with warm water rather than wiping aggressively.

Sitz Baths and Skin Care

Soak in a tub with warm water and baking soda for 15–20 minutes to soothe irritation.
Apply a thin layer of oil, such as olive oil or coconut oil, to keep the skin soft and prevent tearing.

When to See a Doctor

While most anal fissures heal on their own, medical consultation is necessary if:

Pain persists for more than 6 weeks.
Bleeding occurs frequently.
The fissure does not improve despite treatment.
A lump or swelling is present near the anus.

If blood is observed in the stool, it is essential to rule out other conditions such as hemorrhoids or colon cancer.

Gallery

Anal fissure
Fissurectomy wound - initial stage
Fissurectomy wound after 3 weeks
Fissurectomy wound after 12 weeks

@@ Line 1: / Line 1: @@
-An '''anal fissure''', or fissura ani, is a fissure (a small tear) in the anal canal. Patients typically complain of sharp anal [[pain]] during and after [[defecation]], lasting minuters or hours<ref>{{Cite news|url=http://www.webmd.com/digestive-disorders/tc/anal-fissure-topic-overview|title=Anal Fissure-Topic Overview|newspaper=WebMD|access-date=2017-07-17|language=en-US}}</ref>. This small wound can sometimes bleed a little bit during or after defecation.
+'''Anal fissure''', also known as '''fissura ani''', is a small tear in the [[anal canal]], typically causing [[pain]] and [[discomfort]] during and after [[defecation]]. The condition often leads to [[rectal bleeding]], particularly after bowel movements. The sharp, intense pain may last for minutes to hours, making defecation a distressing experience.
-It's not completely clear what causes an anal fissure. It is possibly caused by [[constipation]], too much strain on the anal sphincter (the circular muscle of the anus), reduced blood circulation, the skin is not made dry enough after taking a shower or swimming, the skin has been stretched too much, pregnancy, giving birth, and not changing a baby's diper in time.
+== Causes ==
+The exact cause of an anal fissure is not always clear, but several factors contribute to its development:
+* [[Constipation]] and straining during [[bowel movement]]
+* Excessive tension in the [[anal sphincter]]
+* Reduced blood circulation to the anal region
+* Skin irritation due to improper drying after bathing or swimming
+* Excessive stretching of the anal canal
+* [[Pregnancy]] and [[childbirth]]
+* Delayed [[diaper change]]s in [[infants]]
-After the anal fissure closes, it takes 6 weeks to 3 months before the wound is healed completely. In this period the fissure easily opens again. Therefore, the wound can return repeatedly<ref>{{Cite web|url=https://www.fascrs.org/patients/disease-condition/anal-fissure-0|title=Anal Fissure {{!}} ASCRS|website=www.fascrs.org|accessdate=2017-07-17}}</ref>.
+Once a fissure occurs, it may take 6 weeks to 3 months to fully heal. During this period, the fissure can reopen easily, leading to recurring symptoms.
 == Treatment ==
-A [[Medical doctor|doctor]] can prescribe several products to treat the anal fissure. For example, a pain relieving ointment or suppository (an anal medication); a [[laxative]] (that makes it easier to go to the toilet); zinc-ointment (this will protect the skin and contract it, so it will heal faster)<ref name=":0">{{Cite news|url=http://www.webmd.com/digestive-disorders/tc/anal-fissure-topic-overview#2|title=Anal Fissure-Topic Overview|newspaper=WebMD|access-date=2017-07-17|language=en-US}}</ref>. Further more a doctor can give advice about taking care of the wound and improve [[digestion]] and [[defecation]].
+Management of anal fissures involves a combination of [[medications]], [[lifestyle changes]], and, in some cases, [[surgery]]. Treatment options include:
-Most fissure are acute, lasting about 4-6 weeks<ref>{{Cite web|url=http://proktos.info/anal-fissure/|title=Proktos.info {{!}} Anal fissure|website=Proktos.info|language=en-US|accessdate=2017-07-17}}</ref>. The anal fissure becomes chronic and will not go away if it lasts for more than 6 weeks. In such cases medical [[surgery]] can be a solution. The circular muscle of the anus is usually cut or stretched. Also an injection with botox in the muscle can have a positive result.
+=== Medications ===
+A [[healthcare provider]] may prescribe various treatments to relieve pain, reduce inflammation, and promote healing:
+* '''Topical pain-relief ointments''' – Medications containing local anesthetics can help reduce [[pain]] and [[discomfort]].
+* '''Suppositories''' – Rectal medications that provide relief by coating and soothing the affected area.
+* '''Laxatives''' – To prevent [[constipation]] and ease [[stool]] passage.
+* '''Zinc-based ointments''' – Help protect and contract the skin, promoting faster healing.
+* '''Muscle relaxants''' – Medications such as nitroglycerin or calcium channel blockers may help relax the [[anal sphincter]] and improve [[blood flow]].
-== To prevent the fissure to return ==
+=== Home Remedies and Self-Care ===
-The anal fissure can burst open very easily up to 3 months after healing, for example during defecation. The patient can do several things to reduce the chance that the fissure will return. The advice includes the following tips.
+Patients can adopt several measures to promote healing and prevent recurrence:
+* Eating a high-[[fiber]] diet, including whole grains, vegetables, and fruits.
+* Staying hydrated by drinking plenty of fluids.
+* Using a [[stool softener]] if necessary.
+* Practicing proper [[hygiene]] and ensuring the anal area remains dry.
+* Taking warm [[sitz baths]] 2–3 times daily to relax the [[anal muscles]] and promote healing.
-As long as the fissure is open (a painful, small tear next to the anus which can bleed a little) the patient can put an ointment with zinc oxide (protects and contracts) and pramocaïne (relieves pain and itching) on and around the fissure (in Europe available without prescription as ''Nestosyl''). Use toilet your finger with a glove to spread out the ointment and wash hands afterward with soap. This treatment has to be continued for several weeks to reduce the chance that the fissure will open again.
+=== Chronic Fissure Treatment ===
+If an anal fissure persists for more than 6 weeks, it is classified as '''chronic'''. Treatment options for chronic fissures include:
+* '''Botulinum toxin (Botox) injection''' – Helps relax the anal sphincter, reducing pressure and promoting healing.
+* '''Lateral internal sphincterotomy''' – A surgical procedure where a small portion of the [[anal sphincter]] is cut to reduce tension and improve healing.
+* '''Dilation procedures''' – Involves gentle stretching of the anal canal to reduce pressure.
-Besides it is very important to have a good [[digestion]] and [[defecation]]. The longer the faeces is in the [[intestine]], the more liquid will be withdrawal. Because of this, the faeces will become harder and get more volume, and that gives more chance that the skin around the anus will crack again. Patients are advized to eat [[fibre]]s every day (for example: unpolished rice, muesli, whole grain bread, dried apricots, figs, dates, prunes, saltless nuts, beans, peas, etc.); to eat the recommended amount of [[vegetable]]s and [[fruit]] every day; to use a little bit of butter or oil every day; to drink enough during the day; and to exercise every day. The patient needs to avoid food that can cause constipation (possible: white bread, white pasta/pizza/noodles, eggs, cheese, sugar, coffee, chocolate, etc.). If necessary, one can take [[enzymes]] as food supplement with every meal that includes bread.
+== Prevention ==
+To prevent recurrence, patients should take certain precautions for up to three months after healing. Recommended steps include:
-Patients should not postpone going to the toilet. While waiting, the faeces will push on the circular muscle of the anus, which causes a pressure. Besides the faeces can become harder and get more volume after a while. When the patient feels the urge to go to the toilet, the best thing is to go immediately. While sitting on the toilet, the patient has to press as little as possible, but instead relax the circular muscle.
+=== Dietary and Lifestyle Changes ===
+* Maintain a high-[[fiber]] diet to prevent [[constipation]].
+* Avoid foods that can harden [[stool]], such as white bread, cheese, and caffeine.
+* Drink enough [[water]] daily to keep [[bowel movements]] soft.
+* Engage in regular [[physical activity]] to promote healthy digestion.
-As long as the wound is not healed, taking a daily bath with soda (sodium carbonate) can give relief. Further more that will keep the wound clean. 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 relaxes the tissue and helps relax the anal muscle<ref name=":0" />.
+=== Proper Hygiene Practices ===
+* Ensure the anal area is completely dry after bathing or swimming.
+* Use soft toilet paper or baby wipes instead of rough tissues.
+* Wash the anal region with warm water rather than wiping aggressively.
-It's very important that the skin around the anus is completely dry before the patients gets dressed. The slightest moisture in the folding of the skin can be the reason that the skin will get damaged easily.
+=== Sitz Baths and Skin Care ===
+* Soak in a tub with warm water and baking soda for 15–20 minutes to soothe irritation.
+* Apply a thin layer of oil, such as [[olive oil]] or [[coconut oil]], to keep the skin soft and prevent tearing.
-Some patients benefit by putting simple oil around the anus. For example, olive oil or sunflower oil. The skin softens and will not tear or crack as easily. Always remind hygiene.
+== When to See a Doctor ==
+While most anal fissures heal on their own, medical consultation is necessary if:
+* Pain persists for more than 6 weeks.
+* Bleeding occurs frequently.
+* The fissure does not improve despite treatment.
+* A lump or swelling is present near the anus.
-If the tips that are mentioned above do not help enough and the fissure continues to crack open, the cause could be the use of toilet paper after defecation. The paper rubs too strong over the skin and causes the wound to open again. One can try to use another brand of softer toilet paper, baby wipes, or instead use warm water to clean himself after [[bowel movement]].
+If blood is observed in the stool, it is essential to rule out other conditions such as [[hemorrhoids]] or [[colon cancer]].
-While following all mentioned tips and advice, do not forget the good principles of [[hygiene]].
+== Gallery ==
-These recommendations only make sense if the patient is sure that the problem is an anal fissure. If there is any doubt, especially when there is blood in the stool, please consult a doctor
-== References list ==
-<references />.
-[[Category:Diseases]]
 <gallery>
 File:Anal_fissure_2.jpg|Anal fissure
@@ Line 41: / Line 72: @@
 File:Fissurektomie_Wunde_nach_12_Wochen.jpg|Fissurectomy wound after 12 weeks
 </gallery>
+== See Also ==
+* '''[[Constipation]]'''
+* '''[[Hemorrhoids]]'''
+* '''[[Colorectal surgery]]'''
+* '''[[Digestive system disorders]]'''
+* '''[[Sitz bath]]'''
+{{Digestive diseases}}
+{{DEFAULTSORT:Anal Fissure}}
+[[Category:Gastrointestinal disorders]]
+[[Category:Diseases of the anus and rectum]]
+[[Category:Medical conditions]]
+[[Category:Pain disorders]]
+[[Category:Skin conditions]]
+[[Category:Colorectal surgery]]
+[[Category:Digestive diseases]]