Disease: Anal fissure

Overview

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.

Source: http://www.mayoclinic.com

Symptoms

Signs and symptoms of an anal fissure include:

  • Pain, sometimes severe, during bowel movements
  • Pain after bowel movements that can last up to several hours
  • Bright red blood on the stool or toilet paper after a bowel movement
  • Itching or irritation around the anus
  • A visible crack in the skin around the anus
  • A small lump or skin tag on the skin near the anal fissure

When to see a doctor

See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.

Source: http://www.mayoclinic.com

Causes

Common causes of anal fissure include:

  • Passing large or hard stools
  • Constipation and straining during bowel movements
  • Chronic diarrhea
  • Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease
  • Childbirth

Less common causes of anal fissures include:

  • Anal cancer
  • HIV
  • Tuberculosis
  • Syphilis
  • Herpes

Source: http://www.mayoclinic.com

Diagnosis

If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation.

An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla).

The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition:

  • Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.
  • Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.

Source: http://www.mayoclinic.com

Complications

Complications of anal fissure can include:

  • Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment.
  • Recurrence. Once you've experienced an anal fissure, you are prone to having another one.
  • A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.

Source: http://www.mayoclinic.com

Prevention

You may be able to prevent an anal fissure by taking measures to prevent constipation. Eat high-fiber foods, drink fluids and exercise regularly to keep from having to strain during bowel movements.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences:

  • Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually.
  • Drink adequate fluids. Fluids help prevent constipation.
  • Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure.
  • Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.

If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.

Source: http://www.mayoclinic.com

Risk factors

Factors that may increase your risk of developing an anal fissure include:

  • Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why.
  • Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area.
  • Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.
  • Childbirth. Anal fissures are more common in women after they give birth.
  • Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.
  • Anal intercourse.

Source: http://www.mayoclinic.com

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