An anal fissure is a crack or a tear in the anus or anal canal. Anal fissures occur due to stretching of the outer tissues of the anus. One of the most common causes of anal fissures is from straining to pass large, constipated stools which cause the anal canal to stretch beyond its capability. You may suspect you have an anal fissure if you have a bowel movement and discover bright red blood on the paper and in the toilet. A fissure can be quite painful, and sometimes they don’t heal very quickly due to the natural movement of the anal sphincter during bowel movements. Anal fissures can be very painful during and immediately defecating; the muscles of the anus expand as you are having a bowel movement, which causes the fissure to widen. The strain on the open fissure causes significant pain.
How are anal fissures diagnosed?
The pain of an anal fissure will likely prompt you to see your doctor. Your doctor will ask you questions about the symptoms and how long you have been experiencing them. Your doctor may choose to inspect your anal region without doing an internal examination; an internal examination of the anal canal can be very painful if the fissures are fresh and raw. If you have anal fissures, they should be visible without an internal anal exam.
Your doctor will want to check you for any underlying condition that may be causing your anal fissures. Your doctor may want to do a colonoscopy or at least a sigmoidoscopy. A colonoscopy allows the doctor to examine the entire colon, and a sigmoidoscopy allows the doctor to visually examine the last part of the colon and the rectum.
A colonoscopy is done in a hospital environment under light anesthesia and sedation. You are prepped the day before the examination to empty your bowels. At the time of the examination, you will be required to lie on your left side; the doctor will insert a long tube, which contains a camera, into your rectum and advances it slowly into the colon. The colon is puffed up with air so that the lining of the colon can be examined. A colonoscopy should be used if you are 50 years old or older.
A sigmoidoscopy is similar to the colonoscopy, but it only examines the sigmoid colon, which is the place where the colon and the rectum join. A sigmoidoscopy can be done in the doctor’s office, and does not require anesthesia or sedation. A sigmoidoscopy is much less invasive than a colonoscopy; if you are under the age of 50 and you have never had any diseases of the intestinal tract, your doctor will most likely choose to do a sigmoidoscopy instead of the colonoscopy.
The colon examinations are done to rule out or confirm the presence of an underlying condition such as Crohn’s disease, irritable bowel syndrome, or some other condition that affects the intestinal tract.
How are anal fissures treated?
Anal fissures usually heal themselves within 6 to 8 weeks. Your doctor may suggest that you increase the amount of water and fiber in your diet to make evacuation easier. To help ease the discomfort during the healing process, your doctor may prescribe medicated creams and suppositories to use. Another treatment option is to apply nitroglycerine to the area. Nitroglycerine dilates the blood vessels. The increased blood flow to the affected area should promote healing. Your doctor may also use Botox to immobilize the sphincter muscle to promote healing.
Warnings about nitroglycerine
Nitroglycerine has side effects that could cause headaches, dizziness and low blood pressure. You should apply nitroglycerine to the anal area only when you are lying down, because you could become dizzy if you apply it while sitting on the toilet or while standing. Men being treated for erectile dysfunction should not use nitroglycerine within a 24 hour period of taking an erectile dysfunction drug. Medications such as Viagra, Lavitra and Cialis also have a side effect of causing low blood pressure. Using nitroglycerine on top of an erectile dysfunction drug could be life threatening.
Anal fissures should heal up without surgery, but if they haven’t healed within 6 to 8 weeks, surgery may be necessary. Surgery may involve cutting out the fissure, and any scar tissue that is present. If you have suffered spasms of your sphincter muscle, the surgeon may cut into the sphincter muscle to stop the spasms from occurring.
Assuming that there are no underlying diseases or conditions causing your anal fissures, you may just need to eat more fiber and drink more water to keep your stools soft. You can get more fiber into your diet by eating whole grains, nuts and fruits and vegetables. If your stools are still constipated after adding more fiber, ask your doctor about taking a bulk-fiber laxative daily, such as Metamucil or some other fiber laxative.