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.
Usually, anal fissures heal within a few weeks without treatment. But they can recur and come back when they are caused by constipation that remains untreated. In chronic anal fissures, symptoms last for six weeks or more.
In the case of acute anal fissures, they do not last longer than six weeks. They are common and usually heal on their own with self-care. Anal fissures that last longer than six weeks are called chronic anal fissures, and they may need surgery or medicine to help them heal.
Nitroglycerin ointment is the most effective medicine for relaxing blood vessels and the anal sphincter and treating anal fissures. This ointment needs to be compounded by a compounding pharmacy.
The home remedies for anal swelling are,
- Warm baths that cover the legs help to reduce irritation and ease the swelling caused by hemorrhoids.
- Coconut oil helps to reduce the urge to scratch.
- Aloe vera helps with itching, swelling, and burning when applied to the anus.
- Applying ice packs may relieve pain and inflammation.
- Over-the-counter medications such as Acetaminophen or Ibuprofen may help.
Vaseline or petroleum jelly is good for anal fissures as it helps to lubricate the anorectal area. In addition, soaking in a warm bath for 10 to 20 minutes several times a day, avoiding strained toilet or prolonged sitting on the toilet, and gently cleansing the anorectal area helps to relax the anal muscles.
Engaging in 30 minutes of moderate physical activity, such as walking and exercising most days of the week, helps with anal fissures. Exercise regulars the bowel movements and increases the blood flow to most parts of your body, so it promotes the healing of an anal fissure.
Regular sitting bath, that is, sitting in warm water up to the hips, helps to relax the anal sphincter. Sitting can be painful for people with anal fissures, and also they should not strain during bowel movements.
Most anal fissures heal by following good elimination habits, taking plenty of water and fiber, and avoiding constipation foods and popcorns, tortilla chips, or nuts.
The difference is that they are each a different kind of injury, where anal fissure is a tear of tissue, hemorrhoids occur due to the weakening of cushions of tissue in the lower rectum. This causes the skin to swell up like a tiny balloon and fill with blood.
Hydrocortisone is used to treat itching, minor pain, discomfort, and swelling caused by hemorrhoids and other problems of the anal area, such as itching, anal fissures, etc.
Last reviewed at:
23 Jun 2022 - 5 min read
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