Anal fissures are a natural crack or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on the toilet paper, sometimes in the toilet. If acute they may cause severe periodic pain after defecation but with chronic fissures pain intensity is often less. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature of the anal wall in that location. Fissure depth may be superficial or sometimes down to the underlying sphincter muscle.
Causes:
Most anal fissures are caused by stretching of the anal mucosa beyond its capability. For example, anal fissures are common in women after childbirth, after difficult bowel movements, and in infants following constipation.
Superficial or shallow anal fissures look much like a paper cut, and may be hard to detect upon visual inspection, they will generally self-heal within a couple of weeks. However, some anal fissures become chronic and deep and will not heal. The most common cause of non-healing is spasming of the internal anal sphincter muscle which results in impaired blood supply to the anal mucosa. The result is a non-healing ulcer, which may become infected by fecal bacteria.
Be advised that anal fissures can be confused with a rare cancer such as anal cancer. It is wise to visit your family doctor or a general surgeon if you experience rectal bleeding.
Prevention:
For adults, the following may help prevent anal fissure:
- Avoiding straining when defecating. This includes treating and preventing constipation by eating food rich in dietary fiber, drinking enough water, occasional use of a stool softener, and avoiding constipating agents such as caffeine. Similarly, prompt treatment of diarrhea may reduce anal strain.
- Careful anal hygiene after defecation, including using soft toilet paper and/or cleaning with water.
- In cases of pre-existing or suspected fissure, use of a lubricating ointment (e.g. hemorrhoid ointments) can be helpful.
- In infants, frequent nappy/diaper change can prevent anal fissure. As constipation can be a cause, making sure the infant is drinking enough fluids (i.e. breast milk, proper ratios when mixing formulas. NOTE: See physician before giving infants any fluids outside breast milk and/or formula) may thus help avoid fissures. In infants, once an anal fissure has occurred, addressing underlying causes is usually enough to ensure healing occurs.
Treatment:
Kshar-sutra application at fissure region along with sentinel pile shows dramatic results. Sentinel pile sheds off like pile mass and the wound heals within a week.
Non-surgical treatment is recommended as first-line treatment of acute and chronic anal fissures. Customary treatments include warm sitz baths, topical anesthetics, high-fiber diet and stool softeners.
