ANAL FISSURE
An anal fissure is a small crack or tear in the thin, moist tissue lining the anus.
- The anus is a highly sensitive part of the body, therefore, a small tear in this region can result in severe pain.
- When an anal fissure is present, the two muscles surrounding the anal canal is in spasm, thereby generating a pressure in the anal canal that is abnormally high. These muscles are known as the external and internal sphincter.
- Anal fissures can affect people of any age and sex but are more common in infants and young children.
- It is the common cause of rectal bleeding in infants and young children.
- In most cases, an anal fissure isn’t always a serious condition as the cut or tear heals on its own within four to six weeks. This is called an acute anal fissure.
- In cases where the fissure lasts longer than six weeks, it is considered chronic.
CAUSES
Anal fissures are caused by trauma to the lining of the anus from a stretching of the anal canal. The cause of trauma may include:
- Passing large or hard stools
- Chronic or repeated episodes of diarrhea
- Childbirth
- Constipation
- Anal intercourse
- Crohn’s disease or another inflammatory bowel disease (IBD) can result in an inflammation of the anorectal area
- Sexually transmitted infections such as syphilis, herpes, HIV, and gonorrhea
- In rare cases, anal fissures can result from other underlying medical condition such as anal cancer, tuberculosis, leukemia.
SYMPTOMS
- Pain during bowel movements.
- Deep burning sensation after bowel movements that may last up to several hours.
- A visible tear in the skin that surrounds the anus.
- A skin tag, or a small lump of skin, near the anal fissure (more common when chronic).
- Itching in the anal area
- Bright red blood on the stool or toilet paper after a bowel movement
- Frequent urination or discomfort while urinating, this is less common.
DIAGNOSIS AND TREATMENT
DIAGNOSIS
A doctor will carry out a gentle inspection of the anus to confirm the presence of a fissure. This is done by gently separating the buttocks to pull apart the edges of the anus. The doctor may want to confirm the diagnosis by carrying out a rectal exam.
During this exam, an anoscope (short, lighted tube) is inserted into your anus to inspect your anal canal and make it easier to visualize the tear.
Further testing may be recommended to exclude the possibilities of a more serious disease of the anus or rectum. This may include a flexible sigmoidoscopy to examine the distal end of your colon and a colonoscopy to examine the entire colon. Colonoscopy may be recommended for patients with a family history of colon cancer or patient that are older than 50 (as they have a higher risk for colon cancer).
TREATMENT
Acute renal fissures don’t require extensive treatments as the fissure resolve itself within few weeks. The doctor may encourage the patient to increase their intake of fiber and fluids to keep the stool soft.
If the symptom persists, further treatment may be required.
Nitroglycerin has been found effective in healing anal fissures as it causes the relaxation of the internal and external sphincter.
Botulinum toxin, has been used successfully in treating muscle spasm related disorder, including anal fissure.
Anesthetic cream for pain relief.
Blood pressure medications can help relax the anal spinchter.
Surgery if chronic anal fissure is resistant to other treatments. The surgical procedure mostly performed is the lateral internal sphincterotomy (LIS). In this procedure, a small portion of the anal sphincter is cut to reduce spasm, pain and improve h