What is an anal fissure?

An anal fissure is a tear in the lining of your anus. These small cuts are often a result of passing very large or hard stools. Fissures can be quite painful. They may also bleed during and after you move your bowels.

This condition is quite common in babies. But, it can happen to you at any age. Small tears can heal on their own. Others may need treatment from your doctor or surgery to heal.

Causes of anal fissures

Anal fissures are most often caused by passing large or hard stool. Constipation or prolonged diarrhea can also cause anal fissures.

Other factors that contribute to anal fissures include:

  • Straining during bowel movements
  • Dehydration
  • Lack of fiber in your diet
  • Crohn's disease or other bowel diseases
  • Childbirth

Risk factors for anal fissure

  • Age — anal fissures are more common in infants and middle-aged adults.
  • Constipation — straining during bowel movements puts you at risk for anal fissures.
  • Crohn's disease — causes inflammation of your intestinal tract that can increase your chances of fissures.
  • Childbirth
  • Anal intercourse

Other serious diseases can also raise your risk. These include:

  • Tuberculosis
  • Anal cancer
  • Syphilis
  • Herpes
  • HIV

Symptoms of anal fissure

If you have an anal fissure, you may notice a sharp pain. It happens in or around your anus during bowel movements. You may notice blood when you wipe yourself. You might also see the blood in your stool.

Other symptoms include:

  • Burning or itching of the anal area
  • A visible tear in the skin around your anus
  • Skin tags, or a small piece of skin, next to the tear

Diagnosis of anal fissure

Many anal fissures heal on their own. However, it's important to visit your doctor when you see blood in your stool or experience pain around your anus. Your doctor can do a rectal exam. This helps them find fissure. They can also do tests to make sure you don't have a more serious health condition.

If your anal fissure hasn't healed within six weeks, it's more serious. You may need more treatment. Also, your doctor can see if the anal fissure is actually a tear in the muscles that hold your anus closed. This can make your tear much harder to heal. It may cause discomfort and pain. Even if there are no complications or more serious concerns, your doctor can advise you on how to prevent more anal fissures.

Treatments for anal fissure

The first step to treating anal fissures is caring for yourself. The goal is for the fissure to heal on its own. Start by increasing the amount of non-caffeinated and alcohol-free liquids you drink throughout the day. You may need to also take a fiber supplement to get 20 to 35 grams of fiber every day.

Develop good bathroom habits. Don't ignore the urge to go. Avoid sitting on the toilet too long. Don't strain when you go to the bathroom. Use an over-the-counter laxative, with your doctor's approval. Gently clean and dry your anal area after you're finished.

Sitz baths involve soaking your anal area in warm water a few times a day. You can do this for up to 15 minutes each bath. These can help improve blood flow to the area and relax your sphincter muscle.

Some medications can increase the blood flow to your anal canal. These also help the healing process. Don't use these within 24 hours of taking medication for erectile dysfunction. Calcium channel blockers are another medication treatment.

A final option that some doctors recommend is an injection of Botox into your sphincter. This temporarily freezes the muscle. It can reduce the pain and help the healing process. This may cause you to lose control of your bowel movements or gas for a short period of time. In the long run it may help heal your condition.

Sometimes these treatments don't work. You may need surgery. Your doctor makes a small cut in your sphincter muscle to reduce the pressure and allow your fissure to heal.

Recovery from anal fissure

Your symptoms should disappear within a week or two. If your symptoms aren't gone within two weeks of treatment, make an appointment with your doctor. They can help you figure out a different treatment to try. They may also want to discuss surgery.

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