Definition
A torn anus is a frequently painful tear in the mucous membrane of the anal canal of the anus, which is called the anoderm. Typically (in about 90% of cases) the posterior commissure of the anal canal is affected. This is the back, i.e. the side of the anus facing the coccyx.
Typical symptoms of the torn anus are pain during bowel movement, itching (pruritus) and bright red blood in the stool or on the toilet paper. People between the ages of 30 and 40 are particularly frequently affected by a torn anus; in general, however, a torn anus occurs about equally often at any age and in both sexes. Torn anus also occurs more often than average in children.
With regard to the course of the disease, a distinction can be made between acute and chronic forms of torn anus. The former usually heals after a few weeks, while the chronic form is caused by poor wound healing and the resulting scarring and thickening of the affected skin area. Chronic tears of the anus usually require a surgical intervention under short anaesthesia.
Causes
How exactly a torn anus develops has not yet been fully clarified. It is highly probable, however, that it is the result of various factors that influence each other in the course of the disease. These include, among others, the inherently poor blood supply to the anoderma of the posterior commissure of the anus, which causes tissue damage to heal more slowly and infections to be combated less effectively.
However, the first trigger for the tearing of the anoderma is usually simply hard stool in the context of chronic constipation. This requires strong pressing during defecation, which in turn can cause the first cracks in the mucosa. On the other hand, cracks are also strongly promoted in the case of pre-existing inflammations, such as eczema of the anal mucosa.
These are mainly present in chronic inflammatory intestinal diseases, which are typically accompanied by chronic diarrhoea due to the permanent inflammation. As a result of the inflammatory process, the anoderm loses elasticity and becomes more susceptible to irritation due to the pathologically increased stool discharge. Thus, other intestinal diseases associated with diarrhoea, such as untreated lactose intolerance, can also promote a cracked anus.
Apart from this, certain sexual habits, such as anal intercourse or the anal introduction of objects, also promote a cracked anus. Other risk factors include haemorrhoids and a lifestyle dominated by sedentary activities. Likewise, an increased sphincter tone, i.e. a pathological tension of the anal sphincter muscle, promotes the development of a torn anus.
Symptoms
A ruptured anus is usually accompanied by some very characteristic symptoms, so that a fairly reliable diagnosis can be made on the basis of these alone. Typical symptoms include a bright, stabbing pain when the affected mucous membrane is irritated. During bowel movement a persistent, burning pain dominates.
This leads to a tension of the sphincter muscle up to an anal spasm, through which the stool can only be delivered in a thin strand, described as pencil-strong. The stool may contain bright red blood admixtures. These slight bleedings are usually first noticed by the patient on the toilet paper.
A torn anus is accompanied by very characteristic pain. These can best be described as light and stinging when the damaged mucous membrane is irritated, for example when walking. The pain during bowel movement, on the other hand, is more dominant than a burning, persistent pain, which leads to a tension of the sphincter muscle (sphincter ani) up to anal spasm, making bowel movement even more difficult.
Treatment of severe pain can be achieved by applying an ointment with the addition of a local anaesthetic after the bowel movement. Special suppositories can also be helpful. These are applied to the affected area using a so-called applicator.
Some doctors also decide to inject a local anaesthetic in the case of very severe pain. Occasionally painkillers such as ibuprofen or paracetamol are also prescribed. In the long term, however, it is more important to achieve soft and shaped stool continence by adjusting eating and drinking habits in order to facilitate bowel movement and allow the mucous membrane defect to heal quickly.
Good anal hygiene is particularly important here. This can be achieved by gently cleaning the anal area with a washcloth soaked in lukewarm water and some pH-neutral soap after the bowel movement. Furthermore, depending on the degree of the fissure, further therapeutic procedures are available to achieve rapid healing of the wound and thus pain relief.
