Anal fissure

You may be suffering from anal fissure if you have the following signs and symptoms:

• Pain, sometimes severe, during or after bowel movements that can last up to several hours
• Blood stains on the stool or toilet paper after a bowel movement
• A visible crack or tear in the skin around the anus
• A small lump on the skin near the anal fissure
• Burning and itching sensation around the anus
• Discomfort when urinating or painful urination
• Foul-smelling discharge

An anal fissure is a tear, open sore, or cut in the anus that develops in the lining of the large intestine around the anus and is mainly caused by injury to the area. This can occur when passing a hard, dry, large stool. Several risk factors may contribute to anal fissures or increase the likelihood of developing this condition.

Are you confused between anal fissures and piles? Though they can cause similar symptoms, they are different conditions:

• Anal fissures are tiny cracks or tears in the anus area.
• Piles are primarily swollen blood vessels.

Just like anal fissures, individuals suffering from piles should maintain a fiber-rich diet to prevent painful, hard stools. Read to learn more about other common problems of the anal area that can be a significant concern.

Constipation: It is a condition in which large, hard, and dry stools are difficult or painful to pass. Constipation is more likely to cause lesions in the anal region during a bowel movement.

Here is an informative video about various causes of constipation and their effective management.

Pregnancy and Childbirth: Pregnant women tend to develop anal fissures toward the end of their pregnancy. The lining of the tissues in the anal area may also tear during childbirth.

Muscle Spasms: The spasm of anal muscles can lead to the tearing of the inner lining of the anus during bowel movements, potentially resulting in a chronic anal fissure.

Anal Intercourse: Any trauma to the anal tissue can lead to an anal fissure. There is a high risk of developing anal fissures during rough anal intercourse, as overstretching the skin can cause a fissure.

HIV: HIV-associated anal lesions are among the most disabling anal diseases in HIV-positive patients. Clinically, anal fissures result in pain with defecation, but HIV-associated anal lesions are more likely to cause disabling pain unrelated to bowel movements.

Tuberculosis: Anal tuberculosis can cause non-healing and recurrent ulcer-like fissures in the anal region.

Other Conditions: Some conditions that may cause anal fissures include:

• Crohn's disease (a type of inflammatory bowel disease that causes swelling of the digestive tract)
• Ulcerative colitis (an inflammatory bowel disease that causes swelling and ulcers in the digestive tract)
• Other inflammatory bowel diseases in the anal area
• STDs (sexually transmitted diseases) like syphilis, gonorrhea, chlamydia, and chancroid
• Minor trauma in the anal region caused by activities such as mountain biking, insertion of a rectal thermometer, enema tip, or ultrasound probe
• Weight loss surgery can induce explosive diarrhea

Minor anal fissures may not cause significant problems and often heal on their own. However, chronic cases may require medical attention. Diagnosing the underlying cause is essential for developing an effective treatment plan. The diagnosis consists of the following:

1. Medical History: The doctor will take a detailed medical history, including the patient’s symptoms, eating habits, toilet habits, and medications taken for past or current health conditions.
2. Physical Examination: This involves a visual inspection of the anal region by gently separating the buttocks. If a fissure is not visible, a more thorough rectal examination may be necessary. This is performed after applying a topical anesthetic to the anus and anal canal. A cotton-tipped swab may be gently inserted into the anus to localize the source of pain.
3. Colonoscopy or Sigmoidoscopy: If rectal bleeding is present, an endoscopic evaluation is required to rule out more serious conditions of the anus and rectum, such as colon cancer or solitary rectal ulcer syndrome, which can cause rectal bleeding and straining during bowel movements. A small, flexible tubular device is inserted into the anus to inspect the entire colon.

The following preventive measures and tips can help prevent anal fissures:

• Eat a diet rich in fiber: Fiber improves stool consistency and adds bulk to bowel movements. Intake of foods rich in fiber, such as fruits, vegetables, legumes, nuts, and whole grains, greatly reduces the risk of constipation and thereby anal fissures. A minimum of 18 grams of fiber is recommended for adults daily.
• Stay hydrated: Keep yourself hydrated by drinking a minimum of 8 glasses of water daily, as it will help you pass stools more easily and reduce the risk of anal fissures. Limit your intake of alcoholic and caffeinated drinks, as they can dehydrate your body.
• Do not hold on to the urge to pass stools: Holding stools for too long can strain your anal muscles and lead to hard and dry stools, increasing the risk of constipation and anal fissures.
• Be mindful while taking laxatives: Do not take laxatives without the recommendation of your doctor. Ensure that you use them only for a short period and to treat occasional constipation.
• Stay active: Keep yourself physically active and exercise regularly, as it will help boost your metabolic rate and combat constipation. Aim for 10,000 steps every day.

Treatment for anal fissures mainly includes medications and dietary changes to soften the stools or stimulate their movement through the colon.

Medications

• Topical anesthetic ointments: Patients with anal fissures find relief by applying topical anesthetics such as lidocaine hydrochloride creams to the affected area. These can be either over-the-counter agents or those prescribed by a doctor.
• Nitroglycerin: The application of nitroglycerin ointment to the affected areas increases blood flow to the damaged tissues, which can speed up healing and relieve anal sphincter muscle spasms.
• Calcium channel blockers (CCBs): CCBs like nifedipine or diltiazem reduce blood pressure and relieve anal sphincter muscle spasms. These can be taken orally or applied topically to the affected area.
• Botox injections: If medications are not effective, Botox injections can be used to treat secondary anal fissures. They work by paralyzing the anal sphincter muscles and relieving muscle spasms.

Surgery

If an anal fissure does not respond to medications, your doctor may recommend surgery. This procedure is known as lateral internal sphincterotomy (LIS), which involves making a small incision in the anal sphincter muscle to reduce spasms and promote healing.

The home remedies mentioned below help relieve constipation, allowing the fissures to heal and prevent them from worsening. Along with drinking enough water and being physically active, try these for better results:

Keep Constipation at Bay

Constipation is the main culprit for anal fissures. It can both cause and delay the healing of anal fissures. Hence, it is imperative to manage constipation.

Try a Sitz Bath

A sitz bath or hip bath is a warm water bath that can promote the healing of an anal fissure. You can take a sitz bath with warm water for at least 20 minutes twice daily. The bath should only cover the hips and can be taken with the help of a kit or in the bathtub.

Keep the Anal Area Lubricated

You can try the following to keep the anal area moisturized and lubricated to aid in the easy passing of stools. It is always wise to take consent from your doctor before trying these out:

• Petroleum jelly: Applying petroleum jelly around the anal region can help to lubricate and soothe the skin. Once it is properly lubricated, there are fewer chances of straining and bleeding while passing stools.
• Aloe vera: This plant has healing and pain-relieving properties. Research has found that applying natural aloe vera gel to the affected area can effectively manage chronic anal fissures.
• Coconut oil: Coconut oil has excellent healing properties and works as a natural lubricating agent. Applying coconut oil around the anal region twice a day helps in dealing with anal fissures.
• Olive oil: Olive oil is a rich source of monounsaturated fats. It aids in lubrication, allowing hard, dry stools to pass without discomfort. It also has anti-inflammatory properties, which ease the pain caused by anal fissures. In a study, patients with anal fissures reported reduced pain, bleeding, and itching after applying a natural mixture of olive oil, honey, and beeswax.
• Castor oil: Castor oil is an excellent natural laxative when consumed with milk, and it can also be applied to the anal fissure region to alleviate pain and facilitate easy defecation.

Complications of anal fissure can include:

• Failure to heal: An anal fissure typically heals within six weeks; however, some cases may not heal within eight weeks and are considered chronic. Surgery is the most effective treatment for chronic anal fissures.
• Relapse: After experiencing an anal fissure, there is a high risk of recurrence or the development of another fissure.
• Anal fistula: An untreated or unhealed anal fissure can lead to infection, resulting in an anal fistula. An anal fistula is an infected tunnel between the skin and the anus, causing severe pain, swelling, and discharge of blood or pus from the anus.

Anal fissures can be very painful and discomforting and interfere with a person's daily work. Alternative therapies can be used as an adjunct to conventional treatment.

Yoga

You can try yoga poses as they help you manage your symptoms, like easing bowel movements and keeping constipation in check. Some of the most beneficial ones include:

• Viparita Karani (Legs-Up-the-Wall Pose)
• Trikonasana (Standing Pose)
• Dhanurasana (Bow Pose)
• Matsyasana (Fish Pose)
• Anjaneyasana (Crescent Pose)
• Pavanamuktasana (Wind-Relieving Pose)
• Balasana (Child's Pose)

Anal fissures are very common. Most are self-healing and can be managed by home care. However, in some cases, medications or surgical approaches are required. Here are a few points that could help you deal with anal fissures in your daily life.

• Regular warm sitz baths will help decrease anal fissure pain and discomfort. Keep your bathtub clean after every use. Always use clean and dry towels to reduce the risk of infection.
• Avoid using scented soap and shower gels, as they can cause irritation and worsen your fissures. Instead, use non-perfumed soaps formulated for sensitive skin.
• Sitting too long on the toilet can increase pressure on your lower rectum, especially on the veins in the anal region. Straining during a bowel movement increases the risk of repeated tears and interferes with healing.
• Always gently clean the anal region after defecation to prevent irritation or infection.
• Avoid consuming refined or processed food items, as they can exacerbate your symptoms.
• Always stay hydrated and include fiber-rich foods in your meals.
• Certain medications, such as iron supplements and antacids, can cause constipation, which may predispose you to anal fissures. Your doctor may change your medication to one that does not cause constipation. Always inform your doctor about any changes you may experience while taking a specific medication.