Pain in the anus is one of the most common complaints encountered in outpatient clinics. The patient sometimes describes the pain as 'my worst pain ever. This article provides some suggestions on how to avoid this annoying issue by making a few dietary and lifestyle changes.
An anal fissure is a tear or ulcer that develops in the lining of the anal canal after passing a hard motion. It affects one in ten people at some point in their lives. All age groups and both sexes are affected equally. The anal fissure produces pain and bleeding during bowel movements. Anal sphincter muscle, a ring muscle at the end of your anus, may exhibit spasms.
The following are the most common causes of anal fissure:
Constipation is the most common cause either by itself or as part of irritable bowel syndrome.
Passing large and hard stools.
Less severe causes of an anal fissure are:
It may be part of a more severe condition such as Crohn's or cancer.
Anal fissure has the following manifestations:
Sharp pain when you pass stools, often followed by a deep burning pain that may last several hours.
Lasting pain for several hours after bowel movements.
Bright blood is usually seen on the toilet paper.
It is commonly associated with severe constipation.
Small skin tag or lump near anal fissure.
Crack in the anal skin.
Usually, it resolves over four to six weeks. But, it can recur if there is constipation or hard motion. In some people, the condition turns chronic and lasts for years. Few develop complications such as anal stricture and require surgery.
Stay well hydrated.
Eat a lot of high-fiber foods such as green vegetables, fruits, and oats.
Do not neglect the urge to pass motions.
Complete medical history is obtained from the patient, and a gentle physical examination of the anal fissure is done. In most cases, an anal fissure can be diagnosed with visual inspection as it is often visible.
The cause of the anal fissure can be determined from the location itself. An underlying disorder like Crohn’s disease causes an anal fissure that has an opening on the side rather than having it on the front or back.
An anal fissure can be diagnosed by:
Visual Examination: Acute anal fissure has a fresh tear like a paper cut, while chronic anal fissure exhibits a deep tear along with external or internal fleshy growths.
In addition to physical examination, the following tests can be performed to determine the cause:
Treating constipation with laxatives and stool softeners is the foremost step. Sitz bath (sitting in a warm water bath) for 15 minutes once or twice a day helps in healing by relaxing the sphincter muscles.
Glyceryl trinitrate ointment can be applied locally two to three times a day (this causes a headache which will require Paracetamol 1000 mg tablet), preferably at bedtime. Nitroglycerine or Glyceryl trinitrate ointment is recommended when other treatments do not help. It enhances healing by increasing the blood flow to the anal fissure and relaxing the anal sphincter muscle.
Topical Lidocaine (anesthetic) helps relieve pain.
Botulinum toxin type-A injection relieves sphincter muscle spasms by paralyzing the anal sphincter muscle. Botox injections are given every three months if medical therapy fails.
Oral administration or external application of blood pressure medications like Diltiazem or Nifedipine brings about relaxation of the anal sphincter muscle and is recommended when Nitroglycerine ointment is ineffective.
Surgery: Surgery is the last resort for a few cases that do not respond to conservative management. An anal fissure is surgically treated by lateral internal sphincterotomy, which reduces muscle spasms and pain. If other severe conditions are suspected, a referral to a specialist for further investigations is required.
An anal fissure can be healed by keeping the stools soft by daily taking around 25 to 30 grams of fiber. Whole grains, fruits, vegetables, and nuts are fiber-rich foods. Fiber supplements can be taken if required, but it should be noted that fiber should be taken gradually, as it can produce abdominal bloating and gas problems.
Constipation can be prevented by drinking adequate amounts of water.
Straining during bowel movements should be avoided because it creates pressure that might cause a new tear or open up an already healed tear.
In children with anal fissures, frequently changing the diapers and washing the area gently help promote healing.
Last reviewed at:
23 Dec 2021 - 5 min read
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