What is anal fissure?
Anal fissure is sometimes also called fissure-in-ano. It is a tear in the inside lining of the wall of the anus, running from the outer margin of the exit directly upwards.
In most cases the back wall of the anus is involved, and in almost all cases a swollen skin tag, called a sentinel pile, forms on the outside of the anus at the lower end of the fissure.
The fissure is at the back in 99 per cent of cases in men, but in women about ten per cent are at the front. Fissures situated at the side are usually caused by another disease and this should be investigated.
Because of the number of germs in this area, an anal fissure will usually get infected, so there is local inflammation.
The main symptom of a crack in the rectum is burning pain on defecation. This may be very severe and is often described as a cutting, tearing or burning sensation felt as the stool passes.
There is often bright red bleeding, which may streak the stool or appear on the toilet paper. The pain is worst on the toilet but may last for some hours afterwards. Sometimes it is also difficult to urinate.
Causes of anal fissure
No one knows for certain what causes anal fissure, and it seems likely that several factors contribute to the trouble. Some people are just more liable to suffer the problem than others are.
One of the main factors, however, is the passage of large, hard and fairly dry stools.
Diagnosis of anal fissure
The diagnosis is based on the history of pain on defecation, the appearance of the sentinel pile, and an examination of the anal canal.
Anal fissures usually heal by itself, and this is helped by a high-fiber diet to maintain softness in the stools and to avoid constipation. Your doctor may prescribe a steroid ointment to keep the inflammation down.
Suppositories aren’t helpful because they lie above the level of the fissure.
If fissures recur you may be referred to a surgeon for a simple procedure called anal dilatation or for surgical correction.
How to prevent fissure-in-ano?
Keeping the stools soft with a high-fiber diet and drinking plenty of water is the main way to prevent fissures.
Avoid constipation. Always go to the toilet when you feel the urge. Wash the anal area after each defecation. Bidets are useful.