External Anal Fissures
An anal fissure is a lateral rip or tear in the anoderm, or skin surrounding the opening of the anus and, in some cases, these oval shaped cuts can extend upwards into the anal canal. Commonly occurring in the midline posteriorly in the anal canal which is the area of the anal canal closest to the spine. This area commonly referred to as the external and internal anal sphincter can be prone to uncontrolled spasms and/or contractions which may lead to the tears or fissure occurring in this region.
Fissures can cause severe pain and bleeding during a bowel movement and are quite common in both men and women and affect all ages groups, including infants.
Most Fissures are caused by trauma to the anus and anal canal. Most common sources of trauma to the anal area comes from difficulty passing a hardened stool or repeated episodes of diarrhea, though some patients may have anal fissures caused by the insertion of medical devices or other foreign implements and during childbirth. Less common causes may include inflammatory conditions and certain anal infections or tumors. These fissures are often acute or infrequent and caused by a single event, though some cases are chronic and can be present for long periods of time. Chronic anal fissures are more difficult to treat.
The symptoms of anal fissures are often confused with other causes of anal pain and bleeding, such as hemorrhoids. The symptoms associated with anal fissures are severe pain and bleeding during and especially after a bowel movement. This bleeding will be present on the toilet paper or on the stool, though the appearance of blood in the stool could be a sign of internal bleeding or another more serious trauma.
In the time between bowel movements most patients do not experience pain or any other symptoms related to anal fissures. After a bowel movement and during times of pain associated with the fissures the anal sphincter muscles may spasm, resulting in a decrease of blood flow to the site of the injury. This decrease of blood flow may hinder the healing process and prolong the fissures. Due to the extreme pain associated with fissures, many people become fearful of having a bowel movement and will avoid it which in turn may lead to constipation and stool build up both of which can cause more fissures and prolonged exposure to fissure symptoms.
Treatment for most fissures is a good diet high in fiber. This high fiber diet will help form the stool making it easier to pass. Also stool softeners and increased intake of water will help promote soft movements and aid in the healing process. Using topical anesthetics for pain management in conjunction with warm tub baths will also help greatly. If possible baths should be taken directly after bowel movements for a duration of 10 to 20 minutes to sooth the area and promote relaxation of anal muscles. Narcotic pain medications are not recommended to treat pain associated with anal fissures as most of these medications may cause or promote constipation, which may lead to more fissures.
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