A small, longitudinal tear or defect in the moist layer that lines the anus and the entire back canal is known as an anal fissure. An injury produced by the passage of hard stools or excessive straining during bowel movement might result in a tear in the anal area. They are generally restricted to the dentate line's distal part. Anal canal fissures can be categorized based on their causes.

Types

Primary fissures are often non-threatening and short-lived in nature and are caused by injury to the local tissues. The injury could be caused by passing hard feces, chronic diarrhea, vaginal delivery, repeated trauma, or anal intercourse.

Secondary fissures These fissures are common in people who have had previous anus procedures, as well as those suffering from inflammatory bowel disease, infections, and even cancer.

What is the cause of an anal fissure?

Trauma to the anus and anal canal can result in anal fissures. One or more of the following factors may have contributed to the trauma:

• Constipation that is chronic (long-term)
• Struggling to make a bowel movement, particularly if the stool is huge, hard, and/or dry
• Diarrhea that persists
• Anal sex, stretching of the anastomosis
• Foreign object insertion into the anus

Other causes besides trauma include

• Consistently bad bowel habits
• Anal sphincter muscles that are too tight or spastic (muscles that control the closing of the anus)
• Scarring of the anorectal region
• An underlying medical condition, such as Crohn's disease or ulcerative colitis (both types of inflammatory bowel disease); anal cancer; leukemia; infectious disorders (such as tuberculosis); or sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
• Reduced blood flow to the anorectal region
• Anal fissures are also prevalent in newborns and in mothers following childbirth.

Anal Fissure Symptoms

The most commonly reported symptom of an anal fissure is discomfort, which patients describe as intense and ripping in character, generally while passing stools. This pain may also continue for several minutes to several hours after the feces has been passed.

Bleeding is determined by finding bright red patches of blood on toilet paper, in the toilet bowl, or as streaks on stools. Blood may leak in the form of a drop during feces on rare occasions.

The patient detecting a pile in his or her anal canal on his or her own.

In the case of secondary fissures, the underlying disease's characteristics, such as IBD, tuberculosis, or HIV/AIDS, must be evaluated for further inquiry.

Anal Fissure Diagnostic Evaluation

In the majority of cases, medical history and physical examination of a suspected patient allows for a spot diagnosis of anal fissure based on symptom evaluation without the need for further testing. A fissure can be physically examined by gently separating the patient's buttocks while he or she is laying in a lateral posture. An acute anal fissure can be seen as a fresh cut on examination. Cuts with elevated edges that expose the internal sphincter of the anal muscle fibers, on the other hand, suggest a chronic anal fissure.

A digital rectal examination is not typically necessary to diagnose an anal fissure and is frequently contraindicated due to its pain.

In rare cases, anoscopy or other radiological diagnostic modalities are advised if the fissure is not apparent or the diagnosis is unclear.

A radiological examination is also recommended if the patient has significant brilliant red blood flow and is at high risk of cancer, or if symptoms indicate a secondary anal fissure.

Anal Fissure Treatment

Traditional/Conservative Care

The majority of fissures heal with proper nutritional guidance and a change in lifestyle.

Anal fissures are typically treated by taking steps to soften your feces. Consuming a high fiber diet or taking medications to soften your feces are examples of such strategies.

Warm water baths are also thought to benefit cleanliness, pain treatment, and muscle spasm reduction.

Local anesthetic or topical lotions can also help with fissure healing and can be used as a first-line conservative treatment for fissure pain reduction.

surgical procedure

Patients who are unresponsive to standard treatment are advised to have surgery to fix fissures. Recurrent fissures can also cause scar tissue formation, rendering the anal opening incapable of complete relaxation and necessitating surgical intervention

Patients with refractory or recurrent chronic fissures who have significant symptoms may require surgical therapy, which involves cutting a small bit of the muscle that relaxes or tightens to open or close the anus to pass feces in order to reduce spasm and pain (Lateral Internal Sphincterotomy). In prescription patients, this operation is connected with an excellent recovery rate of around 95%.

Anal Flap Advancement

This approach entails taking healthy dissected tissues from other body parts and using them to repair the fissure and increase blood supply at the damaged spot. This procedure may be chosen for treating long-term anal fissures caused by pregnancy or anal canal damage.