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Anal Fissure

Alternate Names

  • anal ulcer
  • Rectum and Anus

Definition

An anal fissure is a tear in the lining of the anus, an area is called the anal mucosa. This break in the anal lining often reopens during bowel movements. The result is bright red blood and intense pain.

What is going on in the body?

An anal fissure is a tear in the bowel lining. It causes painful, bloody bowel movements. It is often confused with hemorrhoids, which are painful swellings at the anus caused by enlarged veins. A fissure can be acute or chronic. The chronic condition is often associated with a buildup of tissue at the external end of the tear. This is called a sentinel pile and may be noticed by an affected person. The internal end may also have a buildup of tissue that an affected person can rarely see.
When a fissure is present, the mucosa of the anus opens each time it is stretched to allow for a bowel movement. This continual opening prevents healing. It can also leave scar tissue. Most chronic fissures are in the center of the back of the anus.
The anal sphincter muscles need to relax for a person to have a bowel movement. A person with a fissure may have muscles that are too tight. This makes bowel movements painful.

Risks

What are the causes and risks of the condition?

Anal fissures are usually related to abnormal bowel movements. Constipation or frequent stools can cause straining and worsen the problem. Injury to the anal area can also damage the anal mucosa. Pregnancy or difficult delivery is often a cause of this trauma. There are also several medical conditions that can cause anal fissures, including:
  • syphilis
  • tuberculosis
  • Crohn's disease
  • malignant tumors
Venereal warts, which are sexually transmitted warts caused by the Human Papilloma Virus (HPV), can look like anal fissures and may have similar symptoms.

Prevention

What can be done to prevent the condition?

Usually, anal fissures can be prevented by maintaining regularly formed bowel movements. High fiber diets and stool softeners, such as docusate, are often beneficial.

Diagnosed

How is the condition diagnosed?

Anal fissures are diagnosed by physical exam and/or anoscopy. An anoscopy allows the healthcare professional to inspect the anal canal using a special device that opens the anus.

Long Term Effects

What are the long-term effects of the condition?

Untreated anal fissures can lead to anal fistulas, which are abnormal connections between the anus and another organ, usually a different part of the bowel. They can also cause anal stenosis, or an abnormal narrowing of the anal canal.

Other Risks

What are the risks to others?

Anal fissures are not contagious. In the unusual case in which the fissure was caused by an infectious condition, that condition could be contagious.

Treatments

What are the treatments for the condition?

Treatment of an anal fissure depends on how long the fissure has been present. Acute or relatively new fissures can usually be managed with a bulk-forming laxative, such as psyllium, and a local anesthetic cream.
These measures may also help chronic fissures, but more intensive treatment is usually necessary. Nitroglycerin cream or an injection of botulinum toxin (i.e., Botox) may be useful. However, a surgical treatment called a lateral internal sphincterotomy may be needed. This procedure divides the most superficial of the two anal muscles and thus allows easier passage of stool through the anal canal. The operation can be done using a local or regional anesthetic.

Side Effects

What are the side effects of the treatments?

Once the condition is corrected, there are few side effects to anal fissures. However, a person is at risk of developing another fissure if he or she does not make diet or lifestyle changes. The surgery involves the risks of anesthesia, infection, bleeding, and a small risk for stool incontinence (leaking).

After Treatment

What happens after treatment for the condition?

An individual needs to eat a high fiber diets, maintain regular eating habits, and drink plenty of fluids each day.

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