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Anal fissure
Anal fissure is an unnatural crack or tear in the anus, usually
extending from the anal opening and the midline of the anus. Anal
fissure is usually shallow (less than a quarter of inch or 0.64 cm
deep).
Causes
Most anal fissures are caused by stretching of the anal sphincter
muscle beyond its capability. Various causes of this fissure include:
- straining to defecate, especially if the stool is hard and dry
- severe and chronic constipation
- severe and chronic diarrhea
- Crohn's Disease
- rough anal sex
- insertion of foreign objects into the anus
- spastic tight sphincter muscles
- Anal fissure is common in women after childbirth and in infants.
Symptoms
The symptoms of anal fissure include:
- Pain during, and even hours after, defecation
- Visible tear in the anus
- Blood in stool or on toilet paper
- Constipation
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Treatment
A large majority of fissure are shallow or superficial fissure.
These fissures self-heal within a couple of weeks. While waiting for
the fissure to heal, topical or suppository containing
anti-inflammatory agents and local anesthetic can be used.
Furthermore, treatment used for hemorrhoid such as eating a high-fiber
diet, using stool softener, taking pain killer and sitz bath can help.
Anal fissure in infant usually self-heal without anything more than
frequently changing diapers.
Deep fissures, on the other hand, may require surgery. These
painful fissures cut through the sphincter muscle thus making it prone
to spasm, which exacerbates the fissure and aborting the healing
process. Surgical procedures for deep anal fissure are:
- Anal dilation or stretching of the anal canal.
- internal lateral sphincterotomy or excising a portion of the
sphincter.
- Despite the high success rate of these surgical procedures
(~95%), there are potential side effects, which include: risks from
local anesthesia, infection, anal leakage or fecal incontinence.
- Medications can also be prescribed. Nitroglycerine and
nifedipine ointments can relax the sphincter muscle, thus allowing
the healing to proceed. Botulinum toxin injection can also be used
to relax the sphincter muscle.
Prevention
In infants under one year old, frequent diaper change can prevent
anal fissure. For adults, the following can help prevent fissure:
- Treating constipation by eating food rich in fiber, drinking a
lot of water, and taking stool softener
Treating diarrhea promptly
- Lubricating the anal canal with petroleum jelly
- Avoiding straining or prolonged sitting on the toilet
- Using a moist wipe instead of perfumed and harsh toilet paper.
- Keeping the anus dry and hygienic.
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