Anal fissures are small tears in the lining of the anus, often causing discomfort and bleeding during bowel movements. Though common, they can be painful and may require medical attention if they do not heal properly.
Understanding Anal Fissures
An anal fissure occurs when the delicate tissue in the anal canal is stretched beyond its limit, leading to a small tear. This can result in sharp pain, bleeding, and discomfort. Most fissures heal on their own within a few weeks, but chronic fissures may require treatment.
Acute vs. Chronic Anal Fissures
Acute anal fissures develop suddenly and typically heal within six weeks. However, chronic fissures persist longer and may require medical intervention, such as prescription medications or, in some cases, minor procedures to promote healing.
Common Causes of Anal Fissures
Straining During Bowel Movements
One of the most common causes of anal fissures is straining during bowel movements, often due to constipation. Hard stools can overstretch the anal tissue, leading to small tears.
Chronic Diarrhea and Loose Stools
Frequent diarrhea can irritate and weaken the anal lining, making it more susceptible to fissures. Keeping bowel movements regular and well-formed helps reduce this risk.
Underlying Health Conditions
Certain conditions, such as inflammatory bowel disease (IBD), Crohn’s disease, and infections, can contribute to the development of anal fissures by causing inflammation and irritation in the anal area.
Symptoms of Anal Fissures
- Sharp pain during or after bowel movements
- Bright red blood in the stool
- A visible tear near the anus
- Itching or irritation around the affected area
- Muscle spasms in the anal canal
Treatment of Anal Fissures
Most anal fissures heal with proper care, but chronic cases may require medical treatment.
Conservative Treatments
- Increased fiber intake: Softens stools and reduces straining
- Warm sitz baths: Helps soothe pain and promote healing
- Topical creams: Over-the-counter ointments with barrier cream such as vaseline or lidocaine can provide relief
Medications
- Nitrate or calcium channel blocker ointments: Help relax the anal sphincter and improve blood flow to promote healing, these are often paired with lidocaine
- Botox injections: Reduce muscle spasms and aid in fissure healing
Surgical Options
For fissures that do not respond to conservative treatment, a referral to a colorectal surgeon for a lateral internal sphincterotomy may be recommended. This minor procedure involves making a small incision in the anal sphincter to relieve pressure and improve healing.
Preventing Anal Fissures
Healthy Bowel Habits
To prevent anal fissures, it’s essential to maintain softer stools and regular bowel movements. Staying hydrated, eating fiber-rich foods, and avoiding prolonged straining on the toilet can help.
Proper Hygiene and Care
Gently cleaning the anal area with warm water and mild soap after bowel movements can prevent irritation. Avoid using harsh wipes or scented products that may cause further discomfort.
Long-term Diet and Lifestyle Changes
A fiber-rich diet that includes fruits, vegetables, and whole grains can help prevent constipation. Drinking plenty of water and engaging in regular physical activity also contribute to digestive health and reduce the risk of fissures. A trained dietitian can help provide nutritional counseling to help you make a sustainable plan for long-term lifestyle changes.
When to See a Doctor
If you are experiencing persistent anal pain, bleeding, or recurrent fissures, it’s important to seek medical advice. At NYGA, our gastroenterologists offer expert diagnosis and personalized treatment plans to support the healing process and prevent recurrences. Schedule an appointment today to discuss your symptoms and possible treatment options.