An anal fissure is a small tear, cut or an ulcer (an open sore) in the thin moist tissue (mucosa) lining the lower rectum or the anus. These can occur at any age but are highly common in young infants. The risk for anal fissure decreases as age increases. Majority of cases of anal fissure can be treated with appropriate home treatment and usually heal within days to weeks. These are called acute anal fissures. In contrast, chronic anal fissures occur for more than six weeks and may require surgery.
Anal fissures occur in the specialized tissue called the anoderm, which lines the anus and the anal canal. The anoderm contains no hair, sweat glands and sebaceous glands, however, it is rich of nerve endings, thus causing extreme pain when it has a tear. Trauma to the anus causes anal fissures.
What Causes Anal Fissure?
It is believed that excessive tension in the sphincter muscles controlling the anus can lead to anal fissure. The following can lead to too much tension in the muscular rings of the anus:
- Passing large, hard stools frequently that stretches the anal canal
- Constipation and cannot pass hard stools even with repeated attempts
- Chronic diarrhoea
- Reduced blood flow to the area
- After childbirth
- Rectal foreign body
- Anal intercourse
- Crohn’s disease
- Inflammatory bowel disease
What are the Symptoms of Anal Fissure?
Young infants may not always be able to articulate if they are feeling pain when passing stools. Sharp, burning and stinging pain during bowel movement is the most common symptom of anal fissures. The following symptoms are usually present in combination and may appear abruptly or gradually:
- Bleeding after passing bowels
- On the outside of the stool
- On baby wipes or tissue paper
- Bloody diarrhoea
- Yellowish discharge
- Evident crack in the skin when the area is slightly stretched, usually in the middle
- Abdominal pain
- Weight loss
How is Anal Fissure Treated and Managed?
A rectal exam is usually required to get the proper diagnosis. To treat anal fissures, the following tips are recommended. However, the tips from this article should just be used as information and should not be used for medical diagnosis or advice. Join in First Aid Courses to learn a variety of topics that include pain management from a variety of everyday and medical emergencies. To treat and manage anal fissures:
- Take a sitz bath for 10-20 minutes. This is simply immersing the buttocks and pelvic regions of the body in a shallow tub of warm water. Do this two to three times a day, preferably after bowel movements.
- Eat a high fibre diet to soften stools and reduce pain during bowel movements. Drink plenty of water and other fluids.
- Avoid constipation as it may prolong healing time.
- Avoid straining during bowel movements to avoid increasing pressure on the anal tissues.
- Apply topical ointments such as zinc oxide, 1% hydrocortisone, etc. to mollify anal fissure