Anal fissures, small tears in the lining of the anus, the end portion on the rectum, cause considerable pain. Anal fissures commonly occur in infants between the ages of six and 24 months; 80 percent of infants have an anal fissure at some point in their first year, MedlinePlus reports. Anal fissures occur less frequently in older children, but can affect adults. Anal fissures also occur more frequently in women after childbirth.
Causes
Passage of a large, hard, dry stool or constipation and straining normally cause an anal fissure, but diarrhea can also cause a fissure. Older people often experience an increased number of anal fissures, possibly because of reduced blood flow. People with Crohn's disease, an inflammation of the intestinal tract, also tend to develop anal fissures, according to MayoClinic.com. Trauma from anal intercourse can also cause fissures, the Merck Manual states.
Symptoms
Pain, the main symptom of an anal fissure, usually occurs after a bowel movement, and lasts for several hours. Rectal bleeding may also occur. People with fissures may avoid having a bowel movement because of the pain during and after defecation, the American Society of Colon and Rectal Surgeons states, which perpetuates the problem.
Diagnosis
Anal fissures can usually be seen by a physician who examines the rectum. If the fissure can't be seen, taking a medical history usually establishes the diagnosis.
Treatment
Ninety percent of anal fissures heal by themselves or with simple measures within a few weeks, but around 10 percent require surgical repair, the American Society of Colon and Rectal Surgeons states. For infants, just changing the diaper regularly and keeping the area clean promotes healing. Treatments include oral stool softeners, rectal suppositories to lubricate the passage and warm baths. Application of corticosteroid creams help reduce swelling and inflammation. Zinc oxide paste, petroleum jelly or numbing agents applied to the area reduce pain.
Nitroglycerin ointment applied to the fissure increases blood flow, which promotes healing. Botox injections into the anal sphincter cause relaxation of the muscle that lasts up to three months, aiding in stool passage, but temporary incontinence may also result, MayoClinic.com warns.
Complications
Anal fissures that don't heal within six to eight weeks require surgical repair. A cut into small section of the anal sphincter, done as a short outpatient procedure, allows the area to heal. The fissure and any scar tissue formed around it may also be removed, says MayoClinic.com.
Prevention
Preventing anal fissures and treating them as soon as they appear to keep them from becoming chronic involves increasing dietary fiber, drinking plenty of fluids and exercising regularly promote regular bowel movements. Treating diarrhea promptly with anti-diarrheal medications avoids irritation that can lead to anal fissures.
