According to MayoClinic.com, an anal fissure is a tear in the lining of the anal canal. These tears are common in infants aged 6 to 24 months and typically occur in adults from passing hard stools. Patients often notice anal fissures because of a small amount of blood on the tissue paper when wiping after having a bowel movement.
Identification
Symptoms of an anal fissure include pain or burning during and after bowel movements and particularly after bowel movements that are hard or difficult to pass. Patients sometimes note itching of the skin around the anus. There may be bright red blood on the tissue paper after wiping or on the outside of stool. If the area is examined, a crack in the skin is often visible.
Causes
According to the National Institutes of Health, 80 percent of infants will have an anal fissure by the end of the first year. After this, however, anal fissures are less common. In adults, they are often caused by constipation, or the passing of large or hard stools. They can also be seen after a prolonged bout of diarrhea. Women after childbirth are particularly susceptible to developing anal fissures as are patients with an intestinal inflammatory disorder known as Crohn's disease.
Complications
While the symptoms of an anal fissure rarely cause complications, a fissure can become chronic if it does not heal. The fissure can extend into a tear which can involve the internal anal sphincter, a muscle that helps to control bowel movements. According to MayoClinic.com, a tear in this muscle can make healing even more difficult and occasionally requires surgery to repair or remove the fissure.
Diagnosis
The diagnosis of an anal fissure can often be made by a physical exam in which the skin tear is directly visualized. If a patient has other symptoms such as weight loss, frequent bleeding or appetite changes or is over the age of 50, further testing with a colonoscopy may be performed. This test allows the entire colon to be examined by using a long tube with a camera on the end and can help to evaluate for colon cancers. This is important as colon cancer is another common cause of rectal bleeding.
Treatment
If an anal fissure is thought to be related to constipation, the first treatments are to add more fiber to the diet, to drink more water and to attempt regular exercise. To aid in healing and to help relieve symptoms, an anti-inflammatory cream such as anusol may be used. Sitz baths can also help to relieve symptoms. As discussed on MayoClinic.com, a physician may also prescribe a medication such as nitroglycerine ointment which helps to dilate the blood vessels in the rectal area and increase blood flow to assist healing. If the anal fissure continues to cause symptoms and will not heal on its own, surgery to remove or repair the fissure may be needed.
