We know this is a difficult topic to talk about, but there are many people in our society who suffer silently from this problem. Do you also feel an unbearable sharp pain when going to the toilet, especially when passing stool, as if you are being cut by a glass thorn? At the same time, do you sometimes see a few drops of fresh red blood? Then there is a high chance that you also have an anal fissure . Don't worry, this is a very common condition. Today we will talk about this in a very simple way, in a way that you can understand.
Simply put, what is an anal fissure?
An anal fissure is a small tear or crack in the mucous membrane lining the inside of your anal canal. Think of it like your lips cracking when you have a cold. The skin at the end of your anus is very thin and sensitive. A fissure occurs when this thin skin is damaged for some reason. This is often the main cause of anal pain and a small amount of blood in your stool.
This condition can affect anyone of any age. It is especially common among young children, pregnant women, and young adults. For some people, it develops suddenly and gets better on its own within a few days or weeks. For others, it can become a chronic condition that lasts for a long time.
What are the main symptoms of this condition?
A person with a rectal fissure may experience a variety of symptoms. However, there are a few common symptoms that most people experience. I will summarize them in this table to make them easier to understand.
| Symptom | Description |
|---|---|
| Sharp pain | A sharp, stabbing, stabbing pain that occurs when you go to the bathroom, especially when you pass stool. This pain can last for minutes to hours after you have finished defecating. |
| Blood in the stool | A small amount of fresh, light red blood may be seen in the toilet bowl, on the stool, or on the toilet paper. This is not heavy bleeding, usually just a few drops of blood. |
| Inflammation and itching | Burning or itching in the anus after defecation. |
| Rectal muscle spasms (spasms) | Pain can cause the ring-shaped muscles around the anus (anal sphincters) to tighten or spasm spontaneously. |
| A lump on the skin | Sometimes a small lump or skin tag may appear on the skin surface near the incision. |
The important thing is that this pain makes many people afraid to go to the bathroom. But holding in stool only makes the stool harder and the wound worse the next time. It's like a vicious cycle.
Do I have hemorrhoids? Or a fissure in my rectum?
This is a problem that many people have, because the symptoms of both hemorrhoids and anal fissures are very similar. Both can be caused by constipation, both can bleed, and both can be itchy.
But there is a major difference.
- Pain: Nine out of 10 people with anal fissures experience severe pain. But hemorrhoids are not always painful. The pain of hemorrhoids can usually be a dull ache that continues. But the pain of a fissure is typically a sharp, tearing pain that occurs during bowel movements .
- Nature: Hemorrhoids are swollen blood vessels around the anus. They are like varicose veins in the legs. But a fissure is a tear in the skin.
However, if you have these symptoms, it's best to see a doctor for a proper diagnosis rather than trying to decide for yourself whether it's hemorrhoids or a fissure.
Why does this kind of rift occur? What are the main reasons?
This is often caused by trauma to the delicate skin of the rectum. Also, certain health conditions can increase this risk.
Primary causes:
- Constipation: This is the main and most common cause. When stools become hard, dry, and large, you have to strain to pass them. This can stretch and tear the delicate skin of the rectum.
- Chronic Diarrhea: Frequent bowel movements can also damage the skin of the rectum.
- Childbirth: This type of tear can occur due to the pressure during natural childbirth.
- Inserting something into the rectum: for some medical tests or other reasons.
- Infant Dyschezia: This condition can occur even when babies are trying to defecate.
Other conditions that may contribute:
- Previous surgeries related to the rectum.
- Inflammatory bowel disease (IBD), such as Crohn's disease .
- Sexually transmitted infections (STIs).
- Very rare cases such as Tuberculosis (TB) and Anal Cancer .
- Diaper rash worsening.
What complications can occur if this condition is not treated?
Most of the time, these fissures heal within a few weeks with proper care. But sometimes they don't heal and continue to persist. We call this Chronic Anal Fissure . The reason for this is the vicious cycle I mentioned earlier.
Pain causes the muscles in the rectum to tighten (spasm) -> The muscles tighten, causing the fissure to stretch further, and reducing blood flow to the area -> The wound heals more slowly due to reduced blood flow -> The wound does not heal, so the pain persists.
If this cycle continues, other complications may arise.
- Fecal Impaction: When you avoid going to the bathroom due to fear of pain, stool can become stuck in the rectum.
- Anal Stenosis: Scarring from prolonged injury can cause the anus to narrow, making it more difficult to defecate.
- Anal Fistula: An abnormal tube can form between the anus and the skin when the fissure becomes deep and infected. This is a more complicated condition.
How does a doctor diagnose this?
When you go to see a doctor, he will first ask you about your symptoms. Then, he will try to examine your rectum. This is done by turning you on one side of a bed and very gently moving your buttocks to the sides, trying to feel the opening.
Many people are afraid and embarrassed about this test. But remember, this is very common for doctors. If you can't bear the pain, the doctor won't force you to do the test. The disease can often be diagnosed based on the symptoms alone.
If you have less pain, your doctor may gently insert a lubricated, gloved finger into your rectum (digital rectal exam) to check for muscle tightness and other problems. This can help rule out other conditions.
What can you do at home to heal and reduce pain?
The good news is that most anal fissures, especially new ones (acute fissures), can be treated with simple home remedies.
| Remedy | How to do it and its importance |
|---|---|
| Sitz bath (hot water bath) | This is the best and easiest treatment. Fill a large basin with lukewarm water and sit in it for 10-15 minutes, two or three times a day. This will reduce pain and itching. It will also relax the muscles in the anus, increase blood flow, and help the wound heal faster. |
| Changing diet | It is essential to prevent constipation. Eat more fiber-rich foods (beans, lentils, bananas, spinach, oats, fruits, vegetables). Drink at least 8-10 glasses of water a day. This will soften the stool and make it easier to pass. |
| Toilet habits | When you need to go to the toilet, don't delay. Avoid straining. When sitting on the toilet, place a small bench (step stool) under your legs. This will help your body naturally get into a comfortable position for defecation. |
| Cleanliness | After using the toilet, gently clean with unscented or alcohol-free wet wipes or soft toilet paper. If possible, rinsing with water (bidet) is best. |
| Types of coatings | Applying something like petroleum jelly can help keep the skin moist and help it heal. Pain-relieving creams (e.g. Lidocaine) can be used as directed by a doctor. |
If home treatments do not cure it, what are the medical treatments?
If the fissure does not heal for more than 6-8 weeks (Chronic Anal Fissure), it is essential to see a doctor. The main goal of treatment here is to relax the muscles of the anus and give the fissure a chance to heal.
Types of drugs
- Nitroglycerin ointment: This ointment works by widening the blood vessels around the anus, relaxing the muscles, and increasing blood supply to the wound. This helps the wound heal faster. However, some people may experience headaches when applying this.
- Calcium channel blockers: Ointments containing drugs such as nifedipine or diltiazem are also used to relax muscles.
- Botox® injection: If other treatments fail, a Botox® injection can be used as a last resort to treat the anal muscles. This temporarily paralyzes and relaxes the muscles (for about 3 months), allowing the fissure to heal.
- Bulk Laxatives: If constipation is severe, your doctor may recommend medications such as fiber supplements (e.g., psyllium husk).
Surgery
If medication does not help or the fissure recurs, a minor surgery may be required. This is called a Lateral Internal Sphincterotomy .
This involves making a very small incision in the internal sphincter muscle of the rectum under anesthesia, permanently removing the stricture. This is a very successful treatment (more than 90% successful), and the pain disappears quickly after the surgery. You can go home from the hospital the same day.
Take-Home Message
- An anal fissure is a very common and painful condition. Don't be ashamed or afraid of it.
- This condition is often caused by constipation, and can be cured in a few weeks with simple home treatments (scalding with warm water, eating a high-fiber diet, and drinking plenty of water).
- If you have fresh red blood in your stool, unbearable pain, or if you don't feel better after a few weeks, don't waste time and see a qualified doctor.
- Avoid putting off going to the bathroom for fear of pain. This can make the situation worse.
- This condition can be completely cured by properly following the treatment prescribed by the doctor and making a few simple lifestyle changes.
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