10 Frequently Asked Questions About Anal Fissures Answered by Experts

What Is An Anal Fissure?

An anal fissure is a tear near or inside your anal canal. If we go into a textbook definition of fissure-in-ano, it is a longitudinal ulcer or tear, starting from the dentate line to the anal verge. The dentate line is an imaginary line around 2 cm above the anal threshold. 

An anal fissure is like those small cracks on your lips if you are dehydrated.

What Causes Anal Fissures?

Anal fissures have different causes, and according to these causes, they are ; 

Know that 90% of anal fissure cases occur in the posterior midline at 6 O'clock position.

What Are The Symptoms Of Anal Fissures?

If you have ever gone through the pain a fissure-in-ano causes, you would know how painful and difficult defecation is.

Common symptoms of fissure-in-ano are as follows:

• Pain during bowel movement.
• Pain after bowel movement that can last for a few hours.
• Pain while you sit for an extended period.
• Bleeding along with the stools, in little quantity.
• Discharge of colourless fluid, pus if infected or blood.
• Pruritus ani (Itching around anal verge).
• Skin tags at the anal verge.

When your doctor examines your anal canal, he will see a crack on the anal canal or a small skin tag hanging.

How Are Anal Fissures Diagnosed?

Medical experts diagnose anal fissures solely by examining your anal region.

If you experience any of the above symptoms, you have to get personally examined by an expert to come to a final diagnosis.

Medical experts also use advanced investigation techniques in chronic and severe fissure-in-ano diagnosis.

These are as follows:

Anoscopy

A tubular device is inserted into your anal canal so your doctor can see the inside of your anal canal and rectum. If your anal fissure is very painful, experts try to avoid anoscopy.

Sigmoidoscopy

A tube passed into the part of your sigmoid colon (part of your intestine) helps visualise the internal part. Sigmoidoscopy ensures no other symptoms are associated with your anal fissures.

Colonoscopy

To visualise the entire of your anal canal and colons (the intestines). A colonoscopy helps ensure that your anal fissure is not associated with conditions like ulcerative colitis ( ulcers in the colon), Tuberculosis, and Crohn's disease.

During diagnosis, experts do advanced examinations or investigations for anal fissures to understand that your anal fissures have no association with any other systemic conditions.

Can Anal Fissures Heal On Their Own?

Anal fissures heal according to the severity and duration. The longer the cracks are present, the longer they take to heal.

Acute anal fissures are present with a tiny cut near the anal verge. It will be present with acute bleeding and severe pain. These fissures heal by themselves when you control constipation with a proper diet.

Chronic fissure-in-ano takes time to heal as the ulcer or cut formed on the anal mucosa is usually profound. The margins of this cut feel hard and fibrosed with whitish borders. There will be a skin tag hanging at the base of this fissure.

These fissures take longer to heal with proper tests and lifestyle management.

Some anal fissures even need surgical management to heal.

What Are The Available Treatment Options?

The first and foremost treatment option for anal fissure is Lifestyle management.

1. Dietary changes to manage constipation include fibre-rich food, vitamin C diet, and coolant drinks.
2. Avoiding long-duration sitting.
3. Avoiding friction by clothes.
4. Avoiding injury to the anal region, such as by anal intercourse.

Conventional Treatment Choices

1. Local pain-reducing or numbing gels.
2. Laxative medications.
3. Stool bulk-forming medications.
4. Antibiotics to prevent infection in the wound

Surgical Treatment Options

1. Fissurectomy - Removal of the whole fissure from its base.
2. Fissurotomy - Removal of the fissure and keeping the wound open.
3. Sphincterotomy and Sphincterotomy - loosening the tight anal sphincters ( the muscles with which you can open and close the anal opening ) by cutting fibres. 

Ayurvedic Local Treatments

1. Internal medications
2. Local application of medicated coolant ghee or oil.
3. Sitz bath with medicated water.
4. Filling the anal canal with medicated oil or ghee.

Ayurvedic Internal Medications

1. Herbal laxatives
2. Dietary changes to decrease vata and pitta dosha.
3. Intake of medicated ghee
4. Herbal remedies for better digestion metabolism to manage the cause.

Are There Home Remedies for Anal Fissures?

Home remedies for anal fissures are:

• Laxative oils like castor, coconut, and olive oil prevent constipation.
   
• Aloe vera gel for application. It gives a soothing effect.
   
• Ghee or clarified butter for application. It helps in healing the wound.
   
• Applying a mixture of honey and ghee with liquorice skin powder helps in healing.
   
• Sitz bath with warm water for 20-30 minutes.
   
• Vegetables and fruits with high water content like bottled gourd, cucumbers, watermelon, and papaya.
   
• High fibre content diet like green leafy vegetables, drumsticks, oatmeal.
   
• Fissure-healing food like those that contain vitamin C (Citrus fruits, berries).

These are just a list of a few home remedies. Consult Nirva Health experts to know more according to your body's needs.

When Should I Consult a Healthcare Professional?

Anal fissures, even if a mild condition, tends to get complicated in many ways. Please consult your healthcare provider to confirm the diagnosis.

Some of the red flags you should be aware of are-

• A fissure that returns even after completing treatment.
• A long-standing fissure
• Anal fissures with a painful skin tag or mass at the anal verge.
• When your anal surroundings have an inflammation.
• When there is the presence of pus discharge.

Can Anal Fissures Be Prevented?

90% of anal fissure cases occur from chronic constipation. Some are from uncontrolled diarrhoea. Thus, managing your gut health is the best preventive technique for anal fissures.

Find what led to your anal fissure from your doctor, then use the preventive tips.

Some general preventive tips are:

1. Keep hydrated by drinking plenty of water and intake of hydrating food.
    
2. Prevent food that causes constipation.
    
3. Avoid sitting in toilets long, especially in a sitting pose.
    
4. Avoid straining during defecation.
    
5. Clean the anal area thoroughly after defecation.
    
6. Avoid eating a lot of spicy food items.
    
7. Avoid junk and processed foods.

Is Surgery Necessary for Anal Fissures?

No. Surgery is not necessary for all anal fissures.

Anal fissures are well controlled with the help of lifestyle modification and diets.

When these methods do not work, experts suggest surgical procedures.

To Conclude

The anal canal is a very delicate region of your body. But, the best thing is it has such a profuse blood supply that minor injuries and infections heal well. So, the mild pain you face whenever your bowel is constipated vanishes soon. 

However, knowing when to get expert advice for your condition is essential.