Anal fissures are a common condition involving a small tear in the lining of the anus. This tear can cause significant discomfort, often making routine bodily functions quite painful. While generally not serious, fissures can affect daily life and often require attention to heal properly. Understanding these tears and their management is important for individuals experiencing anal discomfort.
Common Symptoms
Anal fissures can be itchy, though itching is typically a secondary symptom. This sensation, known as pruritus ani, occurs as the wound begins to heal. Irritation from discharge or inflammation in the area can also contribute to the itching.
The primary symptom is sharp pain, particularly during and after bowel movements. This pain can feel like tearing or burning and may last for several minutes to hours after defecation. Bright red blood is also often observed on toilet paper or in the toilet bowl after a bowel movement. The anal sphincter muscle can spasm from the pain, which intensifies discomfort and impedes healing.
What Causes Them
Anal fissures primarily develop from trauma to the inner lining of the anus. The most frequent cause is passing hard, dry, or large stools, which can stretch the anal mucosa and lead to a tear. This mechanical injury initiates a cycle where the exposed muscle beneath the tear can spasm, hindering healing.
Other factors can also contribute to the formation of fissures. Chronic diarrhea can irritate and damage the anal lining. Straining during defecation puts excessive pressure on the anal canal. Childbirth is another common cause due to the significant stretching of the anal area. Less common causes can include certain inflammatory conditions.
Treatment and Management
Initial management of acute anal fissures starts with home care strategies focused on softening stools and reducing discomfort. Increasing dietary fiber helps make stools softer and easier to pass. Drinking plenty of fluids also contributes to stool consistency and prevents constipation. Warm sitz baths can help relax the anal muscles, reduce pain, and promote blood flow, aiding healing. Over-the-counter pain relief creams containing lidocaine can temporarily numb the area and alleviate pain.
If home remedies do not lead to healing, medical interventions may be necessary. Topical medications like nitroglycerin ointment can help relax the anal sphincter and improve blood flow, facilitating healing. Calcium channel blocker creams offer another way to relax the anal muscles and blood vessels. For persistent spasms, Botox injections into the anal sphincter muscle can temporarily paralyze it, providing relief and allowing the fissure to heal. Surgery is typically considered a last resort when other treatments have failed.
Preventing Fissures
Preventing anal fissures involves maintaining soft, regular bowel movements to avoid trauma to the anal lining. A high-fiber diet adds bulk and softness to stool. This can reduce the risk of constipation.
Adequate hydration is equally important; drinking plenty of water helps keep stools soft and prevents them from becoming hard and difficult to pass. Avoiding straining during bowel movements is another important preventative measure, as excessive force can cause new tears or reopen healing ones. Promptly responding to the urge to defecate, rather than delaying, can also help maintain softer stool consistency.