Overview
An Anal Fissure is a small tear in the lining of the anal canal. This type of tear may develop in adults from passing hard or large stools during bowel movements. Anal fissure is also common in infants between 6 and 24 months. Anal fissures are less likely to develop in older children.
An anal fissure may cause you to experience pain and bleeding. More than 90 percent heal without surgery, and you can use topical creams or suppositories to provide relief as they heal. Anal fissures that fail to heal may become chronic and cause considerable discomfort. If you develop an anal fissure that doesn't heal, surgery may relieve your discomfort.
Symptoms
- Pain or burning during bowel movements that eases until the next bowel movement
- Bright red blood on the outside of the stool or on toilet paper or wipes after a bowel movement
- Itching or irritation around the anus
- A visible crack in the skin around the anus
Causes
- Large or hard stool passing through the anal canal
- Constipation and straining during bowel movements
- Inflammation of the anorectal area, such as is caused by inflammatory bowel disease (IBD)
- Anal sex, less commonly
Treatments And Drugs
Anal fissures are fairly common and usually heal without treatment or with nonsurgical treatments. Signs and symptoms may go away within two weeks. If the tear doesn't heal within six to eight weeks, however, you may need surgery. For infants, the only intervention necessary may be changing the diaper regularly and keeping the anal area clean. Discuss with your pediatrician ways to avoid constipation and ensure regular bowel movements to prevent your baby from straining.
Nonsurgical Treatments : -
If lifestyle and self-care measures such as adding more fiber to your diet, drinking more water, getting regular exercise, and taking a stool softener or occasional laxative aren't effective,
Your doctor may recommend the following nonsurgical treatments : -
- Medicated creams or suppositories. Your doctor may prescribe a rectal corticosteroid (Anusol, others) or recommend an over-the-counter cream or ointment containing hydrocortisone (Cortaid, Preparation H) to help reduce inflammation and ease discomfort.
- Other nonsurgical therapies. Some doctors recommend applying nitroglycerine ointment to the anus, which widens blood vessels and increases blood flow to the tear, promoting healing. This therapy also helps reduce pressure in the anal sphincter, which eases the spasm and decreases pain, both of which promote healing. The dose of nitroglycerine is small to avoid dangerous side effects. Wash your hands thoroughly after applying the ointment to reduce the amount on your skin even further.
Side effects such as headaches, low blood pressure and dizziness may occur. Your doctor may advise you to remain seated or lying down and to avoid exercise immediately after applying nitroglycerin to minimize these side effects. Men shouldn't use nitroglycerine within 24 hours of taking erectile dysfunction medications such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) because of the possibility of significantly lowered blood pressure.
Another fairly new treatment involves injecting a small dose of botulinum toxin type A (Botox) into the internal anal sphincter. Botox paralyzes the muscle for up to three months, causing the spasm to relax. A possible side effect is temporary, mild leakage of gas or stool (anal incontinence).
Blood pressure medications nifedipine (Adalat) and diltiazem (Cardizem), taken orally or ground into a gel and applied to the tear, also have shown some promise.
Complications
Anal fissures rarely cause complications. If a fissure fails to heal, it may become chronic, which means it's present for more than six weeks. Once an anal tear occurs, it may happen again, leading to repeated injury of the tissue.
The tear occasionally may go into your internal anal sphincter, a ring of muscle that holds your anus closed except during bowel movements. A tear in the muscle usually causes the muscle to spasm, which widens the tear and hampers healing. An unhealed fissure can result in a cycle of discomfort that may require surgery to reduce the pain and repair or remove the fissure.
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