A fissure is a pain-inducing tear in the anal lining during bowel movements. Although it does not cause serious troubles, it can trigger extreme pain and irritation while passing stool. With bowel movements, the tear or crack may even lead to bleeding.
There are acute and chronic anal fissures based on healing time. Acute fissures take a few days to weeks to heal. If they haven’t healed within 8 to 12 weeks, they are considered chronic and require anal fissures treatment.
What are the causes?
Poor bowel movements result in strain, leading to spasm in the muscles causing immense pain. The increased tension in sphincters or overly stretching anal canal causes injury that leads to fissures. It happens while passing stool that is hard due to constipation.
Another reason is prolonged diarrhea or other conditions such as inflammatory bowel disease, Crohn’s disease, etc. Sexual intercourse involving the anus also causes fissures. It also happens when objects are inserted into the anus.
Pregnancy involving vaginal birth also results in fissures. The primary reason is poor eating habits with less intake of fluids and fiber-rich food items. Exerting too much pressure leads to a low blood supply to the anal area, which slows down the tear’s healing.
Other than the reasons specified above, uncommon means leading to fissures include anal cancer, leukemia, sexually transmitted diseases such as HIV, syphilis, herpes, etc.
How to know if one has anal fissures?
- Some common symptoms include hard and large stool that leads to prolonged pain after passing stool.
- Constipation that is lasting for a long time
- Burning sensation and pain during bowel movements
- Bleeding in the anus and blood in stool
- Difficulty in passing urine and discomfort
The doctor can determine an anal fissure based on symptoms as well through specific examinations. The doctor examines the rectum and the anal canal either visually or by gently inserting a gloved fingertip into the anus.
In rectal examination through anoscopy, the doctor uses a thin medical instrument, i.e. a scope, to determine the cause of pain. Insertion of anoscope inside the rectum makes the tear visible and diagnosis easier. In some instances, the doctor might also suggest a colonoscopy to see if the symptoms correlate with other health conditions.
What are the treatment methods?
Treatment methods are determined based on the nature of fissure, that is, acute and chronic. Acute fissures heal in a short period or within a maximum of six weeks, whereas chronic fissures last more than six weeks.
- In case of acute fissures, at the earliest stage, the doctor may advise the intake of food items that are rich in fiber such as whole grains, fruits, vegetables, etc. It helps to avoid constipation.
- Increase the intake of fluids.
- Improve the lifestyle with regular workouts. Physical activities reduce the chance of getting constipation.
- Improve bowel habits by maintaining a routine. Avoid strain while passing stool and take the required time for bowel activity.
- Stool softeners help to prevent constipation. It softens the stool and makes bowel movement easier.
- Taking a sitz bath (sitting in a tub with warm water) for up to 20 minutes per day relaxes the anal sphincter.
- Use creams or ointments that help to soften stool or to relax muscles. But always talk with your doctor before taking any medications.
- If the fissure has not healed within six weeks, a surgical procedure might be required.
Most fissures do not call for surgery except for chronic fissures that are difficult to treat, and for those, surgery is the best option for cure. Doctors recommend surgery if there are severe symptoms and the patient is resistant to other medical non-surgical methods of treatment.
The surgical approach aims at helping anal sphincter muscles to relax, reducing pain and spasm, thereby allowing the healing process. Compared to the traditional surgical method, laser-based surgery is the best anal fissures treatment. Once the surgery is done, the chances of reappearance are significantly less.
In this treatment, a minimally invasive laser is used. The patient receives local anesthesia before performing the surgery that lasts up to 30 minutes. Laser treatment improves the blood flow to the anal area, which results in faster recovery after surgery.
While traditional surgery requires a healing time of 6-10 weeks, recovery is achieved within 3-4 days in a laser-based method. Since no hospitalization is needed, the patients will be able to quickly go back to their work and resume daily day-to-day activities.