Anal Fissure

Overview

Anal fissure is a crack or tear in the tissue that lines the anus. It can affect people of all age groups, but is more often seen in young infants and women.

Signs and Symptoms

Sharp pain during bowel movements, Discomfort or pain when sitting on a hard surface, Bright red blood spots on toilet paper after bowel movements, Visible crack in the skin surrounding the anus

Common Causes

Passing of hard or large stools stretches the anus and increase the risk of anal fissure, Constipation often leads to harder stools, Chronic diarrhea, Multiple pregnancies, Anal intercourse, Inflammatory bowel disease such as Crohn's disease, Anal cancer, Tuberculosis, Syphilis, Human immunodeficiency virus (HIV)

Risk Factors

Passing of hard or large stools stretches the anus and increase the risk of anal fissure, Constipation often leads to harder stools, Chronic diarrhea, Multiple pregnancies, Anal intercourse, Inflammatory bowel disease such as Crohn's disease causes chronic inflammation of the intestines and makes it more vulnerable to tearing, Anal cancer, Tuberculosis, Syphilis, Human immunodeficiency virus (HIV), Women are more likely to develop anal fissure after childbirth, Young infants are more likely to develop anal fissure due to refusal to defecate

Investigation Techniques

Medical history, Physical examination and inspection of the anal region, Anoscopy to visualise the anus and rectum to look for possible underlying cause, Flexible sigmoidoscopy to examine the distal part of the colon to look for possible underlying cause, Colonoscopy to examine the entire stretch of colon to look for possible underlying cause

Treatment and Prevention

Increase fibre and fluid intake, Regular exercise, Soaking in warm water or sitz bath after bowel movements, Topical anesthetic cream, Topical nitroglycerin, Oral medications such as painkillers and blood pressure medications, Botulinum toxin injection, Surgery (lateral internal sphincterotomy)