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Anal Fissures

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Introduction

Anal fissures are not a serious medical condition and can affect people of any age group. Since constipation is a common problem in infants and young children, most cases of anal fissures are known to occur in these age groups.

In most cases, anal fissures resolve on their own in around four to six weeks. It is considered severe only if anal fissures persist beyond eight weeks and Smiles Gastroenterology has the best treatment for fissures, which include laser treatment for fissure.

An anal fissure is a small tear or cut in the thin tissue that lines the anus. The tear can cause severe pain and bleeding during bowel movements and in some cases, patients may even experience spasms in the anal sphincter (a small muscle ring at the end of the anus). Smiles Gastroenterology has highly skilled doctors that recommend the most effective piles and fissure treatments.

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What Causes Anal Fissures?

In most cases, an anal fissure is caused when passing hard or large stools during a bowel movement. Severe constipation or frequent diarrhea may also cause anal fissures in some people.

Common causes of anal fissures include:

  • ● Anal intercourse
  • ● Straining during childbirth
  • ● Bowel movements
  • ● Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
  • ● Overly tight anal sphincter muscles
  • ● A decrease in the blood flow to the anorectal area

In rare cases, anal fissures may also develop due to:

  • ● HIV
  • ● Anal cancer
  • ● Syphilis
  • ● Herpes
  • ● Tuberculosis

What are the Symptoms of Anal Fissures?

The common signs and symptoms of anal fissures include:

  • ● Severe pain during bowel movements
  • ● Pain after bowel movements that lasts for hours
  • ● A tiny lump of skin next to the tear
  • ● A visible tear in the skin around the anus
  • ● Bright red blood in the stool or on the toilet paper after wiping
  • ● Itching or a burning sensation in the anal area

If you or your child experience these symptoms, seek medical assistance immediately.

How are Anal Fissures Diagnosed?

The doctor may ask about your medical history to look for risk factors that may have caused your anal fissures. He/she may then perform a physical examination to gently inspect the anal region and look for visible tears and cuts.

An acute anal fissure may look like a tiny cut in the skin resembling a fresh papercut. A chronic anal fissure may be a deeper cut and have a fleshy growth, either internal or external or both. The location of your anal fissure may help determine its cause as well. For instance, an anal fissure that develops on the side of the anal opening could be due to inflammatory bowel disease, such as Crohn’s disease.

Your doctor may recommend the following tests to confirm the diagnosis of anal fissures:

  • ● Anoscopy The doctor will insert a tiny tube-like device called an anoscope into your anal region to examine the anus and rectum. It will help the doctor determine the location and severity of the fissure.
  • ● Flexible sigmoidoscopy The doctor will insert a small tube equipped with a camera at the bottom of your colon. It will help the doctor determine the location of the anal fissures. This test may be performed only if you are younger than 50 years and have no possible risk factors for intestinal cancer or colon cancer.
  • ● Colonoscopy This test may be done to inspect the entire colon. The doctor will insert a tubular device into your rectum to look for fissures. Your doctor may perform this test if you are older than 50 years, have risk factors for colon cancer, or show signs of other underlying medical conditions.

How are Anal Fissures Treated?

In most cases, anal fissures resolve on their own in a few weeks. To promote healing and to relax the anal sphincter, your doctor may recommend:

  • ● Increasing your intake of fluids and high-fiber foods
  • ● Soaking your anal region in warm water for 10 to 15 minutes a day

If your symptoms continue to worsen, your doctor may recommend alternative treatment options for anal fissures which include:
Non-surgical treatment options
These include:

  • ● Blood pressure medications : To help relax the anal sphincter, your doctor may recommend medications such as Diltiazem or Nifedipine. These medications can either be taken orally as pills or applied externally to the affected region.
  • ● Nitroglycerin : This may help increase the blood flow to the anal region and promote healing of the anal sphincter. Nitroglycerin is considered to be an effective treatment option when other options fail to work. You may experience some side-effects of taking nitroglycerin which in some cases, can be severe.
  • ● Anesthetic creams : Your doctor may recommend topical creams that contain lidocaine hydrochloride to help provide relief from pain and discomfort.
  • ● Injections : An injection of botulinum toxin type A may be given to paralyze the anal sphincter and help relax spasms.

Surgical treatment options
Your doctor may recommend surgery if your anal fissures are chronic and if your symptoms continue to worsen over time.
The surgeon may perform a procedure known as lateral internal sphincterotomy to treat anal fissures. It involves removing a small piece of the anal sphincter muscle to provide relief from pain and spasms and promote healing.

Result The outcome of anal fissure surgery is usually positive. Studies have shown that in severe cases of anal fissures, surgery is proven to be most effective.

What are the Risks associated with Anal Fissures Surgery?

Most cases of anal fissure surgery have no complications, but some patients may experience minor complications such as:

  • ● Fecal incontinence
  • ● Infection
  • ● Unexpected bleeding
  • ● Perianal abscess

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Pregnancy & Fissure

What Is Pregnancy & Fissure?

An anal fissure is a small cut or tear that appears in the anal region after passing hard stools. The tear may cause sharp pain and bleeding during bowel movements. It is a common condition that affects people of all ages but is likely to develop multiple times in pregnant women.

Why Do Anal Fissures Appear During Pregnancy?

Many pregnant women experience pain or discomfort while defecating or sitting for long periods. Anal health issues are a common concern for many pregnant women as hormonal changes can increase your risk of developing anal fissures or hemorrhoids.

Anal fissures are small cuts or tears that appear in the inner lining of the anus. Because the anus is sensitive, even a small cut may cause sharp pain, bleeding, or itching in the area.

During pregnancy, the hormonal shifts along with the increased strain on the pelvic region may develop fissures. However, there are several treatment options available to combat the symptoms.

What Causes Pregnancy & Fissure?

An anal fissure usually occurs after passing hard stools. Some other factors that cause anal fissures are as follows:

  • Constipation: The pregnancy hormones may change your bowel movements and cause constipation. Passing stools while constipated may strain your anal region and lead to cuts or tears due to the hard stools.
  • Straining during childbirth: Another common reason for anal fissures in pregnant women is childbirth. During childbirth, you may put a strain on your anal region and cause tearing.
  • Inflammatory intestinal diseases: Various inflammatory intestinal conditions such as inflammatory bowel disease, ulcerative colitis, or Crohn’s disease may also cause anal polyps.
  • Sexually transmitted diseases: Sexually transmitted diseases (STDs) like HIV, syphilis, or herpes may also lead to anal fissures.
  • Other medical conditions: Other medical conditions like high blood pressure or anal cancer may also make you more susceptible to developing fissures.

What are the Symptoms of Pregnancy & Fissure?

Constant pain in the anus and difficulty passing stools are the most common symptoms of anal fissures. Other signs that may indicate anal fissures are:

  • ● Bleeding from the anus
  • ● Change in the stool color
  • ● Change in bowel habits
  • ● Severe Abdominal pain
  • ● Burning or itching in the anal region
  • ● A small lump on the skin near the tear

How are Anal Fissures Diagnosed in Pregnant Women?

Your doctor may perform the following tests to diagnose anal fissures. Some of them are as follows:

  • Physical exam: Your doctor will first visually check the site of your anus and ask for your medical history.
  • Colonoscopy: In this procedure, your doctor inserts a thin, flexible tube with a camera attached to your anus. The camera transmits images of the rectum and helps detect any tears or bleeding in the skin.
  • Sigmoidoscopy: In this procedure, your doctor will insert a more flexible and thin tube inside your anus. The camera attached to this tube helps check for cuts in the upper part of the rectum.
  • Stool tests: The stool tests help your doctor check for blood in the stool and assess the presence of abnormal cells in the body.

How Is Pregnancy & Fissure Treated?

Anal fissures are generally harmless and may resolve in a few weeks on their own. However, you may have to change your diet and include more fibrous foods to make the stools soft. Moreover, soaking your anal region in warm water for 15–20 minutes may help promote faster healing in the region. However, if you have recurring fissures, the following treatments may be considered:

  • Topical anesthetic creams: Topical anesthetic creams like lidocaine hydrochloride can be applied to relieve pain in the area.
  • Externally applied nitroglycerin: Nitroglycerin is generally applied when other treatments do not work. It helps promote blood flow in the anal region and relax the sphincter muscle.
  • Botox injection: A botox injection may help in relaxing the muscles and reduce spasms.
  • Surgery: If other treatments do not work, your doctor may recommend surgery. Doctors generally perform lateral sphincterotomy (LIS), a surgery in which the surgeon will cut a small portion of the sphincter muscle to relieve spasms and pain.

What are the Results associated with Pregnancy & Fissure Surgery?

Anal fissures during pregnancy are fairly common and harmless. Once diagnosed, it’s necessary to go for regular checkups. If anal fissures become chronic, they may cause skin tags and severe pain. Consume fibrous food to avoid its recurrence.

What are the Risks associated with Pregnancy & Fissure Surgery?

The treatment for anal fissures is simple and does not cause any significant problems in patients. However, it may cause the following complications:

  • ● Itching in the anus
  • ● Perforation in the rectum
  • ● Bleeding from the anus
  • ● Severe pain
  • ● Fever and chills if the area is infected
  • Constipation

FAQ's

How do can I know it is an Anal Fissure and not a Hemorrhoid?

Hemorrhoids last for several days and usually recur. On the other hand, anal fissures cause pain before and during bowel movements. In some cases, you may even experience severe pain for hours after passing stool.

What Happens if Anal Fissures are left Untreated?

If left Untreated, Anal Fissures can cause severe complications such as serious infections or even cancer.

Can Ointments and Creams Heal Anal Fissures?

Some medicated creams and Ointments may help relax the Anal muscles, reduce pain and heal the Fissures.

What type of Food Items should be Consumed during Anal Fissures?

If you develop Anal Fissures, you can help relieve some of your symptoms by drinking plenty of liquids and eating proper meals that include high-fiber foods like fruits and vegetables.

How Long does it take to Recover from Aanal Fissure Surgery?

Complete healing from both medical and surgical treatments may take up to six to 12 weeks, and. you may be able to return to work a few days after your surgery.

What Happens if Anal Fissures are Left Untreated?

If Anal Fissures are left untreated, the following complications may arise:

  • ● Increased swelling in the anal area
  • ● Bowel obstruction
  • ● Increased pain while passing stools
  • ● Bleeding from the anus
  • ● Difficulty in walking or sitting
  • ● Increased risk of infection

What are Some Foods to Avoid if you have Anal Fissure?

Avoid the following food items if you get Anal Fissure:

  • ● Processed foods like bread, biscuits, cakes, etc.
  • ● Coffee, tea, or other caffeinated drinks
  • ● Spicy foods or any frozen pre-prepared foods

How Can Anal Polyps be Prevented?

You can prevent the recurrence of Anal Polyps by:

  • ● Limiting your intake of caffeine
  • ● Maintaining good hygiene and cleanliness
  • ● Drinking plenty of water
  • ● Consuming fruits and vegetables that are high in fiber

How Long Does it take for Anal Fissures to Heal?

After treatment, the fissures may take one to two weeks to heal completely. To ensure faster healing, avoid caffeinated drinks or alcohol. Your doctor may also schedule a physical exam after a week to check for any new fissures

Will Rectal Bleeding Affect My Baby?

No, bleeding from the anus due to fissures will not affect your baby in any way. Rectal bleeding rarely has any connection with your pregnancy, but you may need to mention it to your doctor to rule out any risks.

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