Anal Fissure

What is an Anal Fissure?

An anal fissure is a condition that occurs when a person has a small tear (known as a fissure) in the thin lining inside of their anus. This thin, moist layer of tissue is known as the mucosa or more specifically, the andoderm. The andoderm is highly sensitive and thin tissue with no hairs or other follicles to protect it from tears or damage. Because of this, anal fissures are a common condition in both men and women and are often not considered to be particularly dangerous.

Acute or chronic

Anal fissures can be a one-time, or infrequent issue (an acute anal fissure) or can sometimes be chronic, meaning that they occur frequently. Most often, anal fissures are the result of trauma to the anal canal. This trauma can occur when a large or hard bowel movement passes through the anal canal or can occur due to activities in which foreign objects are inserted into the anus. Certain cancers, childbirth, and even diarrhea and some medical procedures can also cause anal fissures.

What are the Symptoms of an Anal Fissure?

Perhaps the most common symptom of an anal fissure is pain. This pain often occurs when having a bowel movement but can occur at other times as well, possibly for several hours after having a bowel movement. Bleeding from the rectum, particularly during bowel movements can also be a noticeable symptom.

Symptoms include

  • Pain
  • Itching
  • Inflammation
  • Bleeding
  • Irritation around the anus
  • A lump under the skin of the anus
  • A crack or break in the skin of the anus

Anal Fissures Causes

Some people are more at risk of developing anal fissures than others. Infants are susceptible to the condition during the first year of their life, although it is not clear why; it may be as a result of them having particularly sensitive or delicate skin.

Anal fissures can be caused by a wide range of things, with the most common being:

  • Passing hard or very large stools
  • Constipation and straining during passing of stools
  • Chronic diarrhea
  • Anorectal inflammation caused by an inflammatory bowel disease such as Crohn’s
  • Childbirth

Less frequently, anal fissures can occur as a result of the following conditions:

  • Anal cancer
  • Herpes
  • HIV
  • Syphilis
  • Tuberculosis

Older adults are also at an increased risk, in this case due to slowed circulation which leads to decreased blood flow around the rectal area which could make skin more susceptible to damage.

How is an Anal Fissure Treated?

Oftentimes, anal fissures clear up on their own. However, sometimes they require treatment, either to alleviate symptoms or to correct the problem itself.

Treatment includes

Softening the stool while the anal fissure heals can help to prevent further tearing as well as to reduce pain. This can be accomplished through increasing fiber and fluids intake or through prescription (or over-the-counter) stool softeners. Topical creams and/or oral medications may also be used to help reduce pain, relax the anal sphincter, and to promote healing. Of course, surgery may also be necessary for anal fissures that cause severe pain or are chronic and do not respond to other treatments.

Anal Fissures Prevention

Since constipation and diarrhea are two of the most common causes of anal fissure, it is important to consume a diet with lots of fiber to keep stools soft yet solid and regular. Fruits, vegetables and whole grains are all good sources of fiber.

Drinking plenty of water will also help to keep stools soft, but it has the added benefit of keeping skin hydrated too. Skin which is very dry is more at risk of splitting or cracking, so by drinking plenty of fluids you can minimize the risk of fissures.

Individuals who ignore the urge to go to the bathroom could be increasing their risk of developing an anal fissure. Doing so causes stools to become hard, making it more difficult to pass them without straining which could lead to small tears.