Anal Fissure

Anal fissure is a tear in the anal mucosa. Often, it produces sharp pain while defecating, but in certain cases, it may not be painful at all. One obvious feature of anal fissure is the fact that you can see fresh blood outside of the stool or on the toilet tissue following a bowel movement. Be aware that 'fresh' here points towards bright red blood, which is not admixed in the stool. Darker red to brownish blood admixed into the stool would indicate intestinal or colorectal bleeding.

Anal fissures are extremely common in young infants but may occur at any age. Studies suggest 80% of infants will have had an anal fissure by the end of the first year. Most fissures heal on their own and do not require treatment, aside from good diaper hygiene. However, some fissures may require medical treatment.

Anal fissures usually occur when the anal mucosa are overstretched beyond its limits. Most anal fissures which happens suddenly (acute) will heal spontaneously over time, taking up to 2 weeks on average. However, some fissures may not heal as it turns chronic, as a result of spasm of internal anal sphincter muscle. This spasm deprive blood supply to the anal mucosa, thus producing an ischemic ulcer.

Fissures occur more commonly in infants (constipation), adults (constipation, passing of large hard stools, or by prolonged diarrhea) and postpartum women.(after childbirth)

Anal fissure is best treated with normal precautions. Firstly, drink more fluid to rehydrate yourself and prevent constipation. At the same time, soft stools would be able to pass through your bowels without aggravating the injury caused by anal fissure. The same applies to consuming more fruits and vegetables.

If the anal fissure still persists, try consulting a doctor for topical ointments or any other anesthetic if it hurts too much. Sitz bath is also recommended. A sitz bath is a warm water bath used for healing or cleansing purposes. You sit in the bath. The water covers only the hips and buttocks. The water may contain medication.

Please be aware that no scope should be done at the anal or rectal area when the anal fissure is still there. However, a scope should be done when the anal fissure has healed to investigate for any underlying cause of the anal fissure.

The principles of prevention focuses on avoid the irritation of the rectum and anal mucosa. Among the precautions that should be taken are:
  • Keep the anal area dry
  • Wipe with soft materials or a moistened cloth or cotton pad
  • Promptly treat any constipation or diarrhea
  • Avoid straining while defecating
  • Avoid caffeine (as it can increase constipation)

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