Anal Fissure

Definition
An anal fissure is a small tear in the thin lining of tissue (mucosa) around the anus. Although common in young infants, anal fissures can occur in individuals of any age. In fact, anal fissures are a relatively common occurrence, with most fissures being the result of a hard or large bowel movement. While most anal fissures heal within four to six weeks, complications can arise. Medical attention should be sought if an anal fissure fails to heal, recurs, or extends to surrounding muscles.

Causes
Anal fissures are typically caused by a trauma to the lining of the anus, such as a large, hard bowel movement or receptive anal penetration. Additionally, constipation, chronic diarrhea, childbirth, straining during bowel movements, chronic inflammation of the anorectal area, and anal infections can all lead to anal fissures. Less common causes include anal cancer, HIV, tuberculosis, herpes, and syphilis.

Risk Factors
There are a number of health factors that may increase a patient’s risk of developing an anal fissure. Passing hard stools, childbirth, and Chron’s disease (inflammatory bowel disease) make the lining of the anus increasingly vulnerable to tearing. Additionally, reduced blood flow and circulation to the rectal area during old age may increase the risk of an anal fissure.

Symptoms
Because pain and bleeding are common with anal fissures, they may be confused with other colon and rectal problems such as hemorrhoids or perianal abscesses. Nevertheless, symptoms of an anal fissure generally include:

  • Mild to severe pain during a bowel movement
  • Blood in the stool or on toilet paper shortly after a bowel movement
  • Itching around the anus
  • A visible tear to the skin around the anus
  • Tenderness, swelling, or redness around the anus
  • A small lump within the skin around the anal fissure 

Treatments
Most anal fissures heal on their own. Moreover, taking the necessary steps to heal an anal fissure such as increasing fluid and fiber consumption, soaking in warm water several times a day, and taking a stool softener to make bowel movements more comfortable may prevent the need for treatment. If a fissure fails to respond to these treatment modalities, nitroglycerin, steroid creams, injections, medications, or surgery may be considered. 

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