Do you also feel extreme pain when you defecate? A sharp, unbearable pain, like being cut by a glass shard... And then you feel a lot of fear when you see a few drops of blood on the toilet paper or in the commode. This is a problem that many people are ashamed to talk about, and they keep it inside. But it is actually a very common health condition. So let's talk about it openly today.
What is an anal fissure?
Simply put, an anal fissure is a small tear, break, or sore in the skin inside your anal canal. Just like our lips can get chapped, the delicate lining at the end of your anus can become chapped for a variety of reasons. This sore is what causes you that excruciating pain when you have a bowel movement.
This condition can affect anyone of any age, from very young babies to adults. It is especially common in pregnant women and young children.
What are the main symptoms of this condition?
If you have an anal fissure, you may experience one or more of these symptoms:
- Sharp, stabbing pain when defecating: This is the main and most uncomfortable symptom. Some describe the pain as "like walking on glass."
- Pain that lasts for hours: Even after you have finished defecating, you may experience burning or aching pain for several hours.
- Slight blood in the stool: This is usually a small amount of bright red, fresh blood. You may see this on the toilet paper or on the surface of the stool.
- Itching or burning around the anus: This type of discomfort can occur due to the wound.
- A small lump or skin tag near the anus: Sometimes, a skin tag can develop with chronic anal fissures.
Is this hemorrhoids or an anal fissure?
This is a point where many people get confused. It's common for hemorrhoids and anal fissures to be confused because the symptoms are somewhat similar (such as bleeding and itching). However, there are clear differences between the two.
Think about it, hemorrhoids are swollen blood vessels in the anus, like a bunch of veins. But an anal fissure is a tear in the skin.
Let's see what the main differences are between the two.
| Characteristic | Anal Fissure | Hemorrhoids |
|---|---|---|
| Pain | Often (more than 90%) there is a very sharp, stabbing pain during defecation. | There is not always pain. If there is pain, it is often a continuous, heavy pain. |
| Bleeding | Often, a small amount of blood appears as a spot on the toilet paper or a streak on the surface of the stool. | Even without pain, there may be occasional drops or spurts of blood. |
| Feeling a knot | A lump is usually not noticeable. In long-term conditions, a small skin tag may develop. | Soft, lumpy lumps that come out of the anus can be caught in the hand. |
However, if you have symptoms like these, the most important thing is to see a doctor and get an accurate diagnosis, rather than guessing.
Why is this happening? What are the main reasons?
The main cause of anal fissures is damage or trauma to the delicate skin of the anus. There are several factors that can contribute to this.
The main reasons:
- Constipation: This is the number one cause. When stools become dry and hard like rocks, the skin around the anus can stretch, tear, and crack when trying to pass them.
- Childbirth: The pressure during childbirth can damage the area around the anus and cause fissures.
- Chronic Diarrhea: Continuous loose stools can also damage the skin of the rectum.
- Sexual activity: Anal fissures can sometimes occur due to sexual activity.
Other influencing factors:
- Inflammatory Bowel Disease (IBD): Conditions such as Crohn's disease.
- Sexually transmitted infections (STIs).
- Previous surgeries related to the rectum.
- It can also occur as a rare symptom of serious conditions such as rectal cancer .
What will happen if this continues? (Complications)
Most anal fissures (acute fissures) heal within a few weeks with proper care. However, if some fissures do not heal and last for more than two months, we call them chronic anal fissures.
This situation occurs because of a vicious cycle.
1. The anal sphincter muscles around the anus automatically tighten due to pain during defecation.
2. When the muscles tighten, the wound stretches further, and the blood supply to that area decreases.
3. When the blood supply is reduced, wound healing is delayed.
4. Because the wound does not heal, the next time you have a bowel movement, you will experience severe pain again. This cycle continues.
If this continues, conditions such as fecal impaction and anal stenosis may occur.
What treatments can be done at home?
If you can't see a doctor right away when this condition starts, there are some simple things you can do at home to help reduce the pain and discomfort. These will often help the condition get better.
| What to do | Description |
|---|---|
| Taking a Sitz Bath | This is the best thing to do. Fill a large basin with lukewarm water and soak in it for 10-15 minutes. Doing this two or three times a day, especially after a bowel movement, will reduce pain, relax muscles, and help the wound heal. Do not add soap or Dettol to the water. |
| Changing diet | Foods rich in fiberEat more. Include leafy greens like spinach and kale, fruits (apples, bananas), vegetables, oats, and nuts in your diet. These will help soften the stool. Reduce spicy, oily foods for a while. |
| Drink plenty of water. | Drink at least 2-3 liters of water a day. This is essential to prevent constipation. |
| Toilet habits | When you feel the need to defecate, go to the toilet without delay. Don't wait too long. When using the toilet, keep a small bench under your feet. This will make the squatting position easier. |
| Cleanliness | When washing, do not rub vigorously with rough toilet paper, but gently clean with water. You can also use alcohol-free wet wipes. |
What medical treatments are available?
If your condition does not improve after a few weeks of home treatment, be sure to see a doctor. The doctor will listen to your symptoms and, if necessary, perform a gentle examination to confirm the diagnosis. If the pain is severe, treatment may be started based on the symptoms without an examination.
The main goal of treatment is to relax the muscles of the rectum, restore blood flow, and allow the wound to heal.
- Medicated Ointments:
- Nitroglycerin Ointment: This dilates blood vessels, increases blood flow, and relaxes muscles. However, it can cause headaches in some people.
- Calcium Channel Blockers: If nitroglycerin cream fails, creams such as diltiazem are also used to relax muscles.
- Stool Softeners / Laxatives: If constipation is severe, there are medications that can be given to soften stools.
- Botox® injection: If other treatments are unsuccessful, a Botox injection can be given to relax the muscles in the rectum for about three months, allowing the wound to heal.
- Surgery:
Surgery may be recommended as a last resort for persistent fissures that do not heal with any of the above treatments. Internal SphincterotomyThis minor surgery, known as a colostomy, involves making a small incision in the inner muscle of the rectum to permanently remove abnormal firmness. This is a very effective treatment.
Remember, this is a very common condition. So, it's best to see a doctor and get advice without being embarrassed or afraid. Tolerating the pain will only make the situation worse.
Take-Home Message
- Sharp pain during defecation and a small amount of fresh blood are the main symptoms of an anal fissure.
- The main reason for this is constipation and straining to pass stool.
- Most cracks heal within a few weeks with simple care such as eating a high-fiber diet, drinking plenty of fluids, and taking a sitz bath.
- If your symptoms last more than a few weeks or are severe, be sure to seek medical advice.
- There is no need to suffer from pain, as there are very effective medical treatments (ointments, medications, and, if necessary, surgery) for this condition.
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