Anal fissure happens when the anus and the anal canal is cut or torn. Trauma is the major cause of this condition. Common causes are large feces that are dry and hard, tightened anal sphincter or the muscle that open and close the anus, childbirth, and diarrhea. An example of a non-traumatic disease that can cause anal fissure is Crohn’s disease. This is the swelling and inflammation in the lining of the digestive tract. Soreness of the digestive tract may also occur.
If the anal fissure is found laterally, diseases or sickness could be possible causes. These said diseases include acquired immunodeficiency syndrome (AIDS), tuberculosis, leukemic infiltrates, carcinoma, inflammatory bowel disease, or occult abscesses.
There are some risk factors for anal fissure like constipation, diarrhea, straining from bowel movement, prior anal surgery, receptive anal intercourse, Crohn’s disease, and ulcerative colitis.
Anal fissure causes a person to feel pain and discomfort in the anus. The affected area will be sore mostly during and after bowel movements. Other major symptoms associated with anal fissure are bleeding of the anus, itching, and the discoloration of the fecal matter (malodorous discharge). The color of the fecal matter changes to black, tarry, maroon, or red.
What is the most common location for anal fissures? The external or internal sphincter or elsewhere?
Sometimes, anal fissure extends from the anal opening. It is usually located posteriorly in the midline. This may be due to the anal wall in that area, which has a relatively unsupported nature and poor perfusion. Fissure depth may sometimes be down to the underlying sphincter muscle.
Though the external sphincter is the one that is usually affected, some anal fissures can become deep and chronic. The “spasming” of the internal anal sphincter muscle is usually the cause of non-healing anal fissure. This can result to impaired blood supply to the anal mucosa. Ulcer may result to this. It can be non-healing and may also be exposed to fecal bacteria and then cause infection.
The simple way of healing anal fissure is to take lots of water and foods rich in fiber. Whole-wheat bread and oats are the best examples. Fruits and vegetables are also the usual suggestions.
There are also specific ointments and creams to treat anal fissure. These ointments/creams lessen the inflammation and pain in the affected area. Topical nifedipine is a medication that reduces the internal anal sphincter pressure. Nifedipine may be available in pills. Some laxatives are also helpful. Botulinum toxin is injected into the internal anal sphincter muscle. It is a neurotoxin produced by a bacterium, Clostridium botulinum. Its purpose is to paralyze muscles temporarily. The paralyzing effect can reach up to three months. This can be injected without anesthesia or sedation.
Other patients go through surgery. This is usually preferred by people who have taken medical therapy for at least one to three months and still have anal fissure. The process is specifically called lateral sphincterotomy. It allows the internal anal sphincter to relax by cutting a small nick into the internal anal sphincter of the anal canal. Anesthesia is needed for the surgery, and patients are normally fully treated within a week.
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