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8 Causes of Anal Fissure

An anal fissure is a tear or crack in the anus and anal canal. It can be acute or chronic and causes a lot of pain.

causes of anal fissure

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An anal fissure is a tear or crack in the anus and anal canal. It can be acute or chronic and causes a lot of pain.

The initial symptoms include pain during and after bowel movements with bleeding, itching and smelly discharge.

Usually, anal fissure is smaller than one centimeter long, but it still causes excruciating pain. It is because the tear exposes the anal sphincter and the muscle goes into spasm. It is the spasm that causes the pain & discomfort and slow down the healing process.

What are the causes of Anal fissure? 

Anal fissure can develop when the blood flow in the anal region reduces and the mucous lining surrounding the anus becomes dry. The main causes of anal fissure include:

  1. Constipation-During constipation, the feces become large and hard that can traumatize the anal canal during bowel movements, resulting in fissure. 
  2. Straining – Straining during bowel movements can tear the skin in the anal region, causing anal fissure.
  3. Persistent diarrhea – Repetitive diarrhea also can be a cause of an anal fissure as it dries out the mucous membrane of the anal region. The lack of moisture make the skin susceptible to tears and anal fissures start to form. 
  4. Pregnancy and childbirth – Pregnant women have a higher risk of getting an anal fissure in their later pregnancy and during childbirth as they become more prone to constipation, which increases the risk of fissure.  
  5. Sexually transmitted diseases/infections – Syphilis, HIV, HPV, and herpes are the kind of diseases that have an association with a higher risk of having anal fissures.
  6. Anal sex –  Although it happens rarely, but having frequent and rough anal sex can make you vulnerable to anal fissure. The tissues inside the anal canal are very delicate and can tear up during penetration. 
  7. Underlying conditions – Some underlying conditions, like Crohn’s disease and other inflammatory bowel diseases, may cause anal fissures.
  8. Muscle spasms – There are two muscular rings also known as sphincters that control the anus. The outer ring is consciously in control but the inner ring is not and is under constant pressure. It is said that, when the pressure increases to a large extent, the inner sphincter might spasm, decreasing the blood flow and increasing the risk of fissures.
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Who is more at risk of anal fissure?

Anal fissure can develop in people at any age. But younger people are more at risk as they have tight anal sphincter. As people get older, the anal sphincter starts to loosen up reducing the risk of developing anal fissure. People who had suffered from instances of fissure in the past are also more at risk of fissure.

Can stress cause anal fissure?

People often wonder whether stress is one of the causes of anal fissure. And there is a relation between mental stress and development of anal fissure. Stress has a significant impact on the bowel movements (due to release of stress hormone) and make the individual prone to diarrhea and constipation. Besides that, a person dealing with stress will be less inclined to follow a healthy diet, drink enough water, or engage in physical activities. Due to this, the individual often suffer from constipation and fissure may develop. Hence, it can be said that stress causes anal fissure.

When do you need to see a doctor? 

Most people have an acute anal fissure and benefit from home remedies. However, in some cases, home remedies for fissure may fail to treat the symptoms. If you experience any of the following symptoms, you should see a doctor and consult them properly: 

  • Pain during and after bowel movements (also last for hours)
  • Blood in stools, tissue paper, or wipes
  • Visible crack or tear in the anal lining
  • Itching, irritation, and burning sensation in the anal region
  • Discomfort during urination (in some cases)

Anal fissure may heal quickly without intervention. But, in some situations, they can also last for years without treatment. Therefore, you should consult a specialist to explore the treatment options for fissure.

Treatment options for anal fissure

The treatment options are suggested after analyzing the causes of anal fissure. In many cases, home remedies and non-surgical treatments can work effectively to control and manage the symptoms.

Home remedies for anal fissure

Here are some remedies that you can try to treat fissures at home. 

  • Increase fiber intake in your diet
  • Drink enough water/fluid
  • Avoid straining during bowel movements 
  • Use laxatives and stool softeners as prescribed by the doctor

Non-surgical treatments for anal fissure 

Apart from the home remedies, the following non-surgical treatments can also be helpful: 

  • Sitz Bath for 10-15 minutes
  • Over-the-counter ointments for fissure
  • Botox injection to paralyze the anal muscle and relax spasm

When the home remedies and non-surgical methods fail to treat fissures, the patient will have to rely on surgical treatment methods.

Surgical treatment 

Laser surgery for anal fissure is the best treatment. The procedure is performed under general or local anesthesia. During the treatment, if needed, a small section of the anal sphincter muscle is removed to reduce the spasm and provide relief. It improves the blood flow in the anal region and allows the fissure to heal completely at a quick pace. The benefits of laser surgery are: 

  • It is a minimally invasive procedure – no stitches and minimum blood loss
  • Daycare procedure: patient can go home the same day after the surgery
  • Short process: takes 30-40 minutes
  • Quick recovery: takes only 2-7 days 
  • Negligible chances of recurrence 
  • Minimal post-surgery complications
  • Quick return to normal routine

With the help of laser surgery, you can get rid of anal fissure permanently, required that you follow the post-surgery care tips given by the healthcare provider. From the next day of the surgery, you will see the difference in your condition. Within a week after the surgery, you will fully recover.

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Conclusion

The main causes of anal fissure are related to an unhealthy lifestyle. Hence, the best way to prevent fissure or minimize the risk of fissure is to make lifestyle changes related to your diet and physical activities. If you already have fissure and conservative treatments (home remedies and non-surgical methods) are not working, you should seek help from a proctologist or general surgeon as they are experts in treating anal fissures. 

FAQs

Yes, noodles causes anal fissures. Noodles are usually made from white flour that can slow down digestion and bowel movements leading to constipation. Hence, the risk of developing fissure increases significantly if you eat noodles frequently. 

Yes. Anal fissure is a tear that exposes the anal sphincter muscle and increases the risk of damaging the sphincter. If the sphincter is damaged, it can lead to fecal incontinence. 

Anal fissure often comes back if it doesn't heal properly. The usual healing period for anal fissure is 6 weeks. If you fail to eat plenty of fiber and drink enough water, you will get constipated and the healing cycle of the fissure will be interrupted causing the fissure to come back. 

Yes. Drinking alcohol causes dehydration making the mucous lining dry. It will aggravate the symptoms as you pass stools and the tear may become larger causing immense pain. 

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