An anal fissure is a tear in the soft skin tissue around the anus and anal area. It is quite small yet it causes severe pain and bleeding to the patient suffering from it. Bowel movements may also be accompanied by bleeding. Fissures are often mistaken for hemorrhoids and other causes of anal pain and bleeding. However, fissures may occur on both posterior and anterior of the anus. If they are located elsewhere in the anal area, then further examination is needed because it might be indicative of another and more serious disease.
The fissures are caused by distress on the inner lining of the anal area, usually initially caused by constipation or dry bowel movement. In other cases diarrhea and prolonged movement of loose stools can also cause trauma to the soft tissues in the anus. The pain results in sphincter spasm that gives extra pressure on the muscle. Because the blood flow to the area is decreased, natural healing of the fissure is impaired and the rectum swells even more.
Anal fissure can happen because of certain factors such as age, diseases and other medical conditions. The most common factor is constipation – patients strain the soft tissues in the anus by passing large, hard stools. Infant commonly have fissures during their first year while older adults have it later in life due to decreased blood flow. Women experience fissures during childbirth. Crohn’s disease is also a top factor in causing fissures because it affects the intestinal tract. The lining in the anal area become inflamed and susceptible to tearing and swelling.
Not only does anal fissure cause grave pain, it also causes swelling in the rectum and anus. During and after a bowel movement, the stool that passes through the rectum causes the fissure to swell and bleed. Most patients will notice a streak of blood on the stool and in the toilet paper they use after wiping their anus. This causes fear in many patients that they try to avoid bowel movements.
For patients who already have anal fissure, succeeding bowel movements will cause them more pain and spasm. Until it is treated, the blood circulation to the anal area is diminished and the cycle of trauma, swelling and irritation is propagated. Fissures can be complicated by any of the following:
Recurrence. Once you have had fissures, they are likely to come back.
Tear in surrounding muscles. When the fissure extends to the internal anal sphincter, it will take a longer time to heal and the patient will experience more spasms, more discomfort and more pain.
Failure to heal. The fissures should heal within a period of six weeks else it will be deemed chronic and will require further treatment.
Various medication and techniques are employed to interrupt the trauma cycle in the anal areas so that natural healing can take place. The swelling in the rectum may be minimized by applying topical treatments as well as having sitz baths. When the swelling is reduced, patients will not fear bowel movements thereby reducing the risk of constipation.
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