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Anal tears (fissures) are common and probably affect about 1 in 350 people each year. They are more common in people aged between 15 and 40 years but can occur at any age, including in very young children. Women who are pregnant or have recently had a baby are at higher risk of anal fissures, while they are much less common in the elderly.
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The majority of anal fissures are considered primary and typically occur at the posterior midline. A small percentage of these may occur at the anterior midline. Other locations (atypical/secondary fissures) can be caused by other underlying conditions that require further workup.
Your doctor will usually diagnose an anal tear (fissure) by your typical symptoms and by examining the skin around your back passage (anus). No other tests are usually needed but your doctor may arrange some other tests just to check your gut (bowel) and back passage are otherwise okay. How common are anal fissures?
The majority of acute anal fissures is thought to be due to the passage of hard stools, sexually transmitted infection (STI), or anal injury due to penetration. A chronic anal fissure typically is a recurrence of an acute anal fissure.
Often nurses and pharmacists help patients with anal fissures and can provide education about medication used to relieve pain and how to perform sitz baths. If there are untoward consequences or increased pain, the nurse and pharmacist should help the interprofessional team provide a solution.
Primary anal fissures are most commonly located at the posterior midline and less commonly at the anterior midline. Secondary, or atypical, anal fissures are caused by another disease process such as Crohn disease and can occur at locations other than the midline.
Your doctor will likely ask about your medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually this exam is all that's needed to diagnose an anal fissure. An acute anal fissure looks like a fresh tear, somewhat like a paper cut.
SymptomsPain, sometimes severe, during bowel movements.Pain after bowel movements that can last up to several hours.Bright red blood on the stool or toilet paper after a bowel movement.A visible crack in the skin around the anus.A small lump or skin tag on the skin near the anal fissure.
Complications of anal fissure Chronic anal fissure – the tear fails to heal. Over time, this can cause extensive scar tissue at the site of the fissure (sentinel pile). Anal fistulas – abnormal 'tunnels' join the anal canal to surrounding organs, usually other parts of the bowel.
Fissures are usually caused by trauma to the inner lining of the anus from a bowel movement or other stretching of the anal canal. This can be due to a hard, dry bowel movement or loose, frequent bowel movements. Patients with a tight anal sphincter muscle are more likely to develop anal fissures.
1 : a natural cleft between body parts or in the substance of an organ: as. a : any of several clefts separating the lobes of the liver. b : any of various clefts between bones or parts of bones in the skull.
One of the main differences between anal fissures and hemorrhoids is that anal fissures tend to only show symptoms during bowel movements, while hemorrhoids tend to be painful throughout the day. Without an examination, this difference in symptoms is usually very telling of what condition the patient is suffering from.
Research studies showed that, for people with a chronic anal fissure, about 6 in 10 fissures healed with GTN treatment. This compared to about 5 in 10 that healed with no treatment. So, the effect of GTN ointment is modest but may well be worth a try. Other medicines.
Anal fissure treatment. For most people the tear (fissure) heals within a week or so, just like any other small cut or tear to the skin. Treatment aims to ease the pain and to keep the stools (faeces) soft whilst the fissure heals.
Anal fissures are also more common during pregnancy and childbirth. An anal fissure occurs in about 1 in 10 women during childbirth. In a small number of cases, a fissure occurs as part of another condition.
Warm baths are soothing and they may help the back passage (anus) to relax which may ease the pain. A cream or ointment that contains an anaesthetic such as lidocaine may help to ease the pain. You should only use this for short periods (up to 5-7 days).
An anal tear (fissure) causes pain around the back passage (anus). The pain can be really bad and tends to be worse when you pass stools (faeces) and for an hour or so after passing stools. You may also get some bleeding when you pass stools - usually bright red, in the pan or on the toilet paper.
Your doctor will usually diagnose an anal tear (fissure) by your typical symptoms and by examining the skin around your back passage (anus). No other tests are usually needed but your doctor may arrange some other tests just to check your gut (bowel) and back passage are otherwise okay.
This makes the pain worse, which can then increase the muscle tone even more and further slow down the healing process. Constipation can make an anal fissure more likely to develop. There's major variation in 'normal' frequency of bowel-opening between different people.
Complications seen with anal fissures include: Pain and discomfort. Reduced quality of life. Difficulty with bowel movements. Many people even avoid going to the bathroom because of the pain and discomfort it causes. Possible recurrence even after treatment.
Any inflammatory condition of the anal area. Anal fissures may also result from inflammatory bowel disease, surgery, or other medical treatments that affect bowel movements or the anus.
Medicine, Botox injections, and even some topical treatments that improve blood flow, may help anal fissures heal. Other treatments include: Changing your diet to increase fiber and water, steps that will help regulate your bowel movements and reduce both diarrhea and constipation. Taking warm baths for up to 20 minutes a day.
Once the tear happens, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. This causes severe pain. The spasm also pulls the edges of the fissure apart, making it difficult for your wound to heal.
Taking warm baths for up to 20 minutes a day. Taking stool softeners, such as fiber supplements, as needed. Using topical medicines, such as nitrates or calcium blockers. Having surgery, such as a lateral internal sphincterectomy. During the surgery, the pressure inside the anus is released.