This is just a condition similar to any other, which brings pain and discomfort to the patient. Bleeding, pain, or drainage from the anus can occur with several illnesses, so a physician should always be consulted. Often the diagnosis is anal fissure, abscess, or fistula, and these problems are usually easy to diagnose and correct. A variety of treatments, including surgery, are available to correct these conditions, which is only followed by recovery time. Working together with the physician usually assures a positive outcome and results better than you could even imagine.
What are anal fissures and their symptoms?
A typical symptom an anal fissure is extreme pain during defecation, and blood streaking the stool. Patients may try to avoid defecation because of the pain, which leads to constipation. Most people have experienced a tear or fissure at the corner of the mouth that can occur in cold weather or when yawning. Similarly, an anal fissure is a small tear in the lining of the anus, most commonly caused by constipation. A hard, dry bowel movement results in a break in the tissue, although fissures can also occur with severe bouts of diarrhea or inflammation. This results in the anus becoming dry and irritated, causing it to tear; injury to the anal area during childbirth and abuse of laxatives may be other causes. A fissure can be quite painful during and immediately following bowel movement, because the anus and anal canal are ringed with muscles to control the passage of stool. The problem is accentuated when the muscles are trying to keep the anus tightly closed at other times.
When those muscles expand the fissure is stretched open, with bleeding or itching. A simple visual examination of the anus and surrounding tissue usually reveals the fissure, and it is quite tender when examined by the physician. Fissures are most often located in the middle posterior section of the anus.
Treatment of anal fissures
Treatment of anal fistula often varies, depending on whether Crohn's disease is present. (This is a chronic inflammation of the bowel, including the small and large intestine.) As noted, the physician will often perform tests to see if this disease is present in addition to an anal fissure. If it is, prolonged treatment with a variety of medications, including antibiotics, is most commonly undertaken. In most cases these medications will cure the infection and heal the fistula. If Crohn's disease is not present, it still may be worthwhile to try a course of antibiotics, but if these do not work, surgery is usually very effective.
An acute fissure is managed with non-operative treatments. In over 90% cases it will heal without surgery. Bowel habits are improved with a high fiber diet, bulking agents, stool softeners, and plenty of fluids. It is important to use these substances to avoid constipation and promote the passage of soft stools. Warm baths for 10-20 minutes several times each day should also help by soothing and promoting relaxation of the anal muscles. Occasionally, special medicated creams may be recommended in some cases of anal fissures.
A chronic fissure is a fissure lasting more than one month. Chronic fissures may require additional treatment. Depending on the appearance of the fissure, other medical problems such as inflammatory bowel disease or infections may be considered. In these cases testing may be recommended. A manometry test may be performed to determine if anal sphincter pressures are high; examination under anesthesia may be recommended to determine if a definite reason exists for lack of healing. Antibiotics in anal fissure treatment may be used for a short time. The doctor could also choose special medicated creams, especially if the fissure has become ulcerated or infected. It is important to keep the anus and area between the buttocks clean and dry during treatment. After bathing, the patient should gently pat dry with a soft towel, applying talcum powder. This is frequently recommended together with treatment. Sit baths may help relieve discomfort and promote healing. This involves soaking the anal area in warm (not hot) water for 15-20 minutes several times a day.
What if a fissure does not heal?
If the fissure is not responding to treatment, the physician should re-examine the patient. There are conditions, such as muscle spasm or scarring, which could interfere with the healing process. Anal fissures that do not heal can be corrected with surgery. It is a minor operation, usually done on an outpatient basis where the surgeon removes the fissure and any underlying scar tissue. Cutting a small portion of the anal muscle prevents potential spasms. This will also help the area to heal, and rarely interferes with the control of bowel movements.
Recovery of anal fissures
Complete healing takes place in a few weeks although the pain often disappears after a few days. Over 90% of the patients who need surgery for fissures have no further problems. Patients can help avoid the return of fissures by drinking at least eight glasses of water a day. They could also help their recovery process by maintaining adequate fiber in the diet. This prevents constipation, which is the cause of most anal fissures.
If the problem returns without an obvious cause, the person may need further assessment. This may include anal manometry testing or an exam under anesthesia. Many patients with anal fissures are afraid that anal fissures could lead to colon cancer. This is not true, and such fears are unsubstantiated. However, it is important to evaluate persistent symptoms carefully, since conditions other than fissures can cause similar symptoms. Once your doctor is sure you just have an anal fissure, you should not be afraid of the possibility of colon cancer. Just focus on your recovery process and healing this fissure.
How common are anal fissures?
Anal fissures may have an unrepresentatively high hit rate, but maybe not considering the very significant shelf space at drug stores devoted to hemorrhoid treatments, laxatives, and stool softeners. There is obviously a big demand for these products, although several doctors said that anal fissures as well as hemorrhoids are very common.
How to prevent them?
Preventing anal fissures is often a matter of addressing the factors that contribute to their development, with a focus on maintaining soft stools and minimizing stress on the anal canal.
Eating a diet rich in fiber is key to this. By including ample fruits, vegetables, whole grains, and legumes in your meals, you can ensure that your stools remain soft and regular. It's also essential to stay well-hydrated by drinking plenty of water throughout the day. Some people might need to be cautious about the consumption of spicy foods, caffeine, or dairy, as these can sometimes irritate the digestive system and lead to constipation or diarrhea, which can increase the risk of fissures.
Good bowel habits go a long way in preventing anal fissures. It's important to respond to the body's natural urges for bowel movements and not to delay them. Delay can lead to harder stools and increase the likelihood of straining, which should be avoided. When cleaning after a bowel movement, it's gentler on your body to use soft, unscented toilet paper or pre-moistened wipes.
Regular physical activity is another important component of preventing fissures as it can help regulate bowel movements. If constipation is an issue, a healthcare provider might suggest the occasional use of laxatives or stool softeners, but these should be used under medical guidance.
In some situations, such as after childbirth, special care may be needed to manage bowel movements to reduce the risk of developing fissures. Improving toilet ergonomics can also help; for instance, using a footstool can create a squat-like position which can facilitate easier bowel movements.
When needed, topical treatments might be recommended by a doctor to help relax the anal sphincter. This is especially useful for those who frequently develop fissures. It's also vital to address any underlying conditions that might be contributing to bowel issues, like inflammatory bowel disease.
Difference between anal abscesses and fistulas
There is a significant difference between these two conditions, and they should not be considered equal. An abscess is a localized pocket of pus caused by bacterial infection, which can occur in any part of the body. When bacteria seep into the underlying tissues in the anal canal, an abscess may develop. Patients with conditions that reduce the body’s immunity, such as cancer or AIDS, are more likely to develop anal abscesses.
You should know that an abscess causes tenderness, swelling, and pain. These symptoms clear when the abscess is drained, but patient may also complain of fever, chills, and general weakness or fatigue.
A fistula, on the other hand, is a tiny channel or tract that develops in the presence of inflammation. In some cases a fistula develops because of an infection. It may or may not be associated with an abscess, but like abscesses, certain illnesses such as Crohn’s disease can help fistulas develop. The channel usually runs from the rectum to an opening in the skin around the anus, although sometimes the fistula opening develops elsewhere. For example, in women with Crohn’s disease or obstetric injuries, the fistula could open into the vagina or bladder, not just in the anal region. Since fistulas are infected channels, there is usually some drainage and most commonly draining fistula is not painful, but it can irritate the skin around it.
An abscess and fistula often occur together. In fact, if the opening of the fistula seals over before the fistula is cured, an abscess may develop behind it. Diagnosis of an abscess is usually made on examination of the affected area. If it is near the anus, there is always pain, and often redness and swelling associated with these conditions.
The physician will look for an opening in the skin, and try to determine the depth and direction of the channel or tract of the fistula. However, signs of fistula and abscess may not be present on the skin’s surface around the patient’s anus. In this case, the physician uses an instrument called an anoscope to see inside the patient’s anal canal and lower rectum. Whenever the physician finds an abscess, and especially a fistula, further tests are needed to be sure the patient does not have Crohn's disease. Blood tests, x-rays, and a colonoscopy are often required for a positive diagnosis.