An anal fissure is a tear in the mucous membrane that lines the anus and the anal canal. This condition often leads to pain, itching, burning and bleeding during bowel movements, as well as as to a visible crack in the skin around the anus. Anal fissures are relatively common in young infants, but can occur in patients of all ages. While most anal fissures heal on their own within 4 to 6 weeks, some require surgery.
Causes of an Anal Fissure
The most common cause of an anal fissure is constipation, since the passage of large hard stool may tear delicate anal tissue. Other causes of anal fissures include:
- Chronic diarrhea
- Anal sex
- Anal cancer
Anal fissures sometimes appear as secondary symptoms of other illnesses, particularly inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis or sexually transmitted diseases, such as herpes simplex, syphilis, and HIV. While anal fissures are common in infants during the first year of life, they also occur frequently in older patients who have poor blood circulation. In general, patients with a medical history that includes an anal fissure are at increased risk of developing another.
Symptoms of an Anal Fissure
Symptoms of an anal fissure may include the following:
- Blood in the stool
- Painful bowel movements
- Anal irritation or itching
- Cracks in the skin surrounding the anus
Some patients with anal fissures also experience spasms of the anal sphincter.
Treatment of an Anal Fissure
While many anal fissures can heal on their own with no treatment, patients with troublesome symptoms that do not respond to a fiber-rich diet, increased water intake, stool softeners and regular exercise may require a specialized treatment plan. Depending on the severity of the condition, a medicated cream, suppository or BOTOX® injection may be recommended to reduce inflammation in the affected area.
For anal fissures that are not responsive to conservative treatments, surgery may be required. Surgery involves severing a part of the sphincter muscle to reduce the spasms that are causing pain. The fissure and any scar tissue that has developed are removed in order to restore the muscle to full function. This procedure is performed on an outpatient basis and is considered safe and highly effective in most cases.
Prevention of an Anal Fissure
Patients can reduce their risk of developing an anal fissure by preventing constipation, the most common cause of the condition. It is recommended that patients eat foods high in fiber, drink plenty of fluids and maintain a program of regular exercise. In attempting to prevent develop of an anal fissure, the focus is on reducing strain during bowel movements.