An anal fissure is a tear in the anal skin. Such a tear is noticeable by pain during defecation as well as blood in the stool or on the toilet paper. The cause is often problems with bowel movements. The sensitive skin in the anal canal can be damaged if the stool is too hard and the patient has to push hard. Acute anal fissures can usually be treated well with ointments or creams. A chronic fissure, on the other hand, may also require surgery.
Causes of an anal fissure
The skin in the anal canal – also called the anoderm – is very sensitive. If the skin tears and an elongated tear forms, it is called an anal fissure. The exact causes for the development of such a fissure have not yet been clarified. However, the consistency of the stool seems to play an important role. For example, the development of an anal fissure can be promoted by strong pressing during bowel movements – for example in the case of constipation. However, persistent diarrhea and hemorrhoids can also have a negative effect on the anal skin. If the fissure occurs as a result of a chronic intestinal disease such as Crohn’s disease or ulcerative colitis, it is referred to as a secondary anal fissure.
Blood and pain as symptoms
If an anal fissure is present, it is often manifested by severe, burning or stabbing pain during bowel movements. Likewise, itching, burning or oozing in the anal area can be symptoms of an anal fissure. Bright red blood is also often found on the toilet paper or in the stool. As a result of the pain during bowel movements, the patient may have a restrained bowel movement. However, this only hardens the stool and further irritates the sore. If the pain causes the anal sphincter muscles to tighten, the pain may increase even more. In addition, the anal skin is less well supplied with blood due to the cramped muscles. Therefore, it is important that those affected maintain their toilet rhythm as much as possible and break the pain cycle.
Acute and chronic anal fissure
Anal fissures are basically distinguished between an acute and a chronic variant. Acute fissures usually heal within a few days. However, if the symptoms of anal fissure do not improve within a few weeks, a chronic anal fissure may be present. Typical of a chronic fissure is that a thickened skin fold forms at the anus (outpost fissure). Likewise, fibromas – benign connective tissue nodules – and scarred marginal ridges may develop around the ulcer.
Which doctor can help with an anal fissure?
If you have blood in your stool, you should always see a doctor to have a serious condition ruled out. If you suspect an anal fissure, it is best to first contact your family doctor – he will probably refer you to a proctologist. This is a specialist in diseases of the rectum. The proctologist will perform an examination of the external anal area. If an anal fissure is present, he can often detect it without further examination. If this is not the case, he must palpate the anus from the inside. This is usually only done after a local anesthetic, as the examination may otherwise be associated with pain. If an endoscopy of the rectum must be performed, this is also only done under anesthesia.
Treat anal fissure with ointments and creams
An acute anal fissure can often be treated just by regulating bowel movements. Be sure to drink plenty of fluids and eat enough fiber. This can be found in fruits, vegetables and whole grain products. Regular exercise also helps to stimulate digestion. Local anesthetic ointments or suppositories can help against the pain during bowel movements. In some circumstances, the doctor may also inject an anesthetic directly into the area of the anal fissure. The local anesthetic can break the pain cycle and promote healing. For both acute and chronic anal fissures, ointments that improve blood flow to the sphincter and relax the cramped muscles are also suitable for therapy. They usually contain active ingredients from the group of calcium antagonists or nitro preparations. Due to the effect of the preparations, the fissures often heal without further treatment.
Home remedies for anal fissure
In the case of an anal fissure, you should always consult a specialist and not spend a long time trying to alleviate the problems yourself using home remedies. Nevertheless, some tips can help to relieve the pain and support the healing process:
- Warm sitz baths: the warmth of the water can relax the sphincter muscle and thus prevent constipation. An anal shower or bidet can also help relax the muscles after a bowel movement and prevent additional irritation from toilet paper.
- Psyllium husks: a teaspoon of psyllium drunk on about 200 milliliters of water, bind liquid and thus provide a softer stool.
- Anal dilator: by regularly stretching the sphincter muscle with the small plastic cone, the tension of the muscles eases over time. Anal dilators come in different sizes. Somewhat smaller are so-called anal fissure pins.
Application of anal dilators
An anal dilator is inserted into the anal canal to stretch it as well as the sphincter. To do this, apply a little ointment, such as zinc ointment, to the front part of the anal dilator or anal fissure pen. Place on your side with your knees drawn up and insert gently. Initially, pain may be experienced during use, but this should improve over time. It is best to use an anal dilator in the morning and evening and leave it in the anal canal for a few minutes at a time. Regular use can speed up the healing of an anal fissure.
Surgery as a last resort
However, an anal fissure cannot always be treated with home remedies, ointments and creams alone – in some cases, surgery is necessary. This is usually the case if the outpost fissure or fibroids are severe. Likewise, surgery must be performed if an anal fistula has formed. In the case of an outpost fold or scarred tissue, the doctor tries to remove the affected tissue as flat as possible (fissurectomy). While in the past the sphincter muscle was often cut, this form of surgery is rarely performed today. This is because it can lead to fecal incontinence at an older age. After an operation, it usually takes several weeks for the wound to heal. During this time, it is especially important to keep the stool soft by drinking enough fluids and fiber. Wound healing can be aided by ointment dressings and sitz baths.
Preventing an anal fissure
The best way to prevent an anal fissure is to eat a healthy, balanced diet. Consume enough fluids every day: ideally, it should be between one and a half and two liters of water daily. Also make sure that your diet contains enough fiber: Choose whole grain products and fruits and vegetables. In this way, you can keep your stool soft and thus avoid heavy straining during bowel movements. In addition, sufficient exercise is important to stimulate bowel activity and thus prevent anal fissure.
