Definition
An anal fissure is a very painful, mostly longitudinal tear in the anal mucosa. In most cases, the symptoms are pain during bowel movement, itching and sometimes blood deposits on the stool. Anal fissures can occur in patients of any age.
However, they occur most frequently between the ages of 30 and 40. Acute anal fissures usually heal after a few days, whereas chronic fissures with scarring can persist over a longer period of time. The cause may be increased pressure of the external sphincter muscle, chronic constipation, infections or an association with chronic inflammatory bowel disease.
Causes
The causes of an anal fissure can be very different. It is assumed that a chronic, i.e. over a longer period of time, existing pressure increase in the anal area plays an important role in the genesis. Such an increase in pressure can be caused not only by chronic constipation but also by a greatly increased pressure in the area of the external sphincter muscle.
A constipation leads to a hard bowel movement, which can only be evacuated by strong pressing. The particularly thin and sensitive skin in the anal region can tear quickly due to the hard consistency of the stool or also during the pressing process. As a result of prolonged diarrhoea or very mushy stools, the skin in the anal region is also highly irritated and pre-damaged and can promote the appearance of fissures.
Hemorrhoids also promote the development of anal fissures. Due to infections or chronic inflammatory intestinal diseases such as Crohn’s disease or ulcerative colitis, the mucous membrane is less supplied with blood, becomes more irritated and can quickly show small fissures. In most cases, an existing anal fissure causes severe pain so that bowel movements are avoided. As a result, the stool hardens and when the stool is defecated again, the mucous membrane becomes additionally irritated and can tear further. A vicious circle develops and chronic fissures can develop.
Symptoms
A fissure in the area of the anal mucosa causes very strong, stabbing and above all burning pain during bowel movement. It can also lead to blood deposits on the stool or toilet paper. Most patients also report severe itching in the area of the anus and a weeping effect.
The open areas continuously release wound secretions, so that underwear must be changed frequently. In addition, the spots burn and in very pronounced cases patients can no longer sit without severe pain. The shame that many patients experience leads to an involuntary cramping of the sphincter muscle, as they try to avoid the painful withdrawal of the stool.
Due to the cramping of the musculature, the next time the patient goes to the toilet, more pressure must be applied and a further tearing of the fissure is encouraged. After the fissure has existed for some time, a particularly noticeable thickened skin develops in the affected area. In addition, blood may be deposited on the stool or toilet paper.
Most patients also report severe itching in the anal region and a weeping effect. The open areas continuously release wound secretions, so that underwear must be changed frequently. In addition, the spots burn and in very pronounced cases patients can no longer sit without severe pain.
The shame that many patients experience leads to an involuntary cramping of the sphincter muscle, as they try to avoid the painful withdrawal of the stool. Due to the cramping of the musculature, the next time the patient goes to the toilet, more pressure must be applied and a further tearing of the fissure is encouraged. After the fissure has existed for some time, a particularly noticeable thickened skin develops in the affected area.
In the course of an anal fissure, pain occurs which is described by the patients as very strong and stinging. They occur mainly during bowel movement and continue for a few minutes to sometimes several hours afterwards. In the area of the anal mucosa there are many sensitive nerve endings which are the trigger for the strong pain described as particularly unpleasant.
The pain is directly related to the bowel movement and has a very sharp and tearing character. In addition, many patients describe a burning sensation in the wound area, which becomes even worse when the affected area is cared for. The more the mucous membrane is irritated and tears further, the stronger and more persistent the pain. They can become so strong and unbearable that patients can no longer sit properly on their buttocks. They often spend a lot of time in a standing or lying position to escape the pain.
