What Causes an Anal Fissure?
An anal fissure is caused most often by tension and straining of the anal sphincter, the muscular rings that circle the anus and govern how it relaxes or contracts. Passing a particularly large bowel movement, straining during constipation, or repeated use from diarrhea can all result in tears to the mucosa. It may help to compare this to how muscles can tear from a workout, only instead of lifting weights you are passing—or attempting to pass—a large mass of feces.
Trauma to the anal canal can also result in a fissure. Common sources of trauma to the site include childbirth, anal intercourse, rectal exams, and the insertion of a foreign object. Additionally, anal cancer, HIV, tuberculosis, syphilis, herpes, and the inflammation from Crohn’s disease can all weaken the lining of the anus and make it more susceptible to developing tears. Circumstances or conditions that slow circulation, like old age, can also increase your risk of developing a tear.
For reasons that no one quite understands, infants are particularly vulnerable to anal fissures and most experience at least one during their first year.
Symptoms of an Anal Fissure
The most apparent symptom of an anal fissure is the condition’s namesake itself. If you were to look at the anus you would likely see a crack or cut in the skin, possibly branching off from the anal opening. A small lump or skin tag may also be present. The site of the fissure may also be itchy or show signs of irritation. You may also experience anal spasms depending on the location of the fissure.
Other than its physical presence, an anal fissure makes itself known through pain and blood. When you pass a bowel movement the fissure is going to hurt, sometimes severely so. The pain usually lessens after the movement has passed but can persist for up to several hours. Additionally, you can expect to see bright red blood on either the toilet paper or in the bowl from the bleeding fissure. Bright red blood means that the source is somewhere along the lower part of the intestinal tract (like the anus)—if the blood is dark then you have something else going on and should consult your doctor.
Anal fissures are usually diagnosed from a visual examination but a colonoscopy may be used in cases where the tear is in the internal part of the anus. If an underlying condition (e.g. Crohn’s disease) is suspected, then your doctor may want to perform additional tests.
Complications
Anal fissures that persist for over six weeks are considered chronic and may require more advanced treatment options. Additionally, if a fissure is large enough to penetrate into the anal sphincter itself then you will be faced with a recurrent cycle of discomfort and pain that becomes resistant to healing without possible surgical intervention.
Home Remedies for Anal Fissures
In most cases an anal fissure will repair itself within a few weeks. During that time, your goals are to minimize trauma and agitation to the area and to help promote circulation to ensure proper healing. There are a number of steps you can take to accomplish this:
- Lubrication: If you apply petroleum jelly or a similar lubricant to the anus prior to passing a bowel movement you will both ease the pain from the fissure and prevent it from being further aggravated by a potentially hard stool or straining.
- Aloe vera: When used as a gel or ointment or even as a compress, aloe helps soothe the site of the fissure and reduce inflammation (if any).
- Pillows: Much like with an external hemorrhoid, you should avoid sitting on hard surfaces in order to help keep the pressure off the rectal area. Sitting on a pillow is a good way to provide needed cushioning.
- Wiping: Keeping the site of the fissure dry and clean is key for a speedy recovery. After a bowel movement, blot-dry rather than wipe to avoid irritating the fissure. Also, avoid scented, dyed, or otherwise infused toilet paper products since their contents can further aggravate the site. You can also employ baby powder to help keep the area clean.
- Sitz bath: A sitz bath is a sort of anal wash or cleanse that you can employ on its own or following a bowel movement to help soothe an anal fissure.
- Fiber: The less straining at the bowl, the better. Upping your fiber intake with foods like whole grains, leafy vegetables, and prunes will help keep you regular and prevent painful passing. Water and fruit juice can also aid in passage.
- Laxatives: Laxatives to promote passage of bowel movements and stool softener to increase comfort should be used carefully as they can both help and hinder your recovery if the wrong type is employed. If you are considering the use of a laxative or stool softener, talk to your doctor to make sure you’re using the right type.
Other Options
If your anal fissure takes more than six weeks to heal, talk to your doctor. They will be able to investigate any underlying causes that are preventing the fissure from healing. If necessary, surgical repair is also possible. This can involve the use of Botox to paralyze the sphincter and release pressure on the fissure or the division of the sphincter to accomplish a similar effect.
Even after your fissure is repaired, you should try and maintain healthy bowel habits to prevent a reoccurrence.
Sources for Today’s Article:
“13 Home Remedies For Anal Fissure,” Find Home Remedy web site; http://www.findhomeremedy.com/13-home-remedies-for-anal-fissure/, last accessed December 15, 2015.
“Anal Fissure,” American Society of Colon and Rectal Surgeons web site, https://www.fascrs.org/patients/disease-condition/anal-fissure, last accessed December 15, 2015.
“Anal Fissure,” Mayo Clinic web site, December 4, 2012; http://www.mayoclinic.org/diseases-conditions/anal-fissure/basics/definition/con-20024998.