Anal Fissures
Anal fissures are tears or cracks in the anus. Fissures result from stretching the anal mucosa beyond its normal capacity. Once the tear occurs, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. This causes severe pain. The spasm also pulls the edges of the fissure apart, making it difficult for the wound to heal. The spasm then leads to further tearing of the mucosa during bowel movements. This cycle leads to the development of a chronic anal fissure in approximately 40 percent of patients.
An acute anal fissure typically heals within six weeks with conservative treatment. Some disappear when constipation is treated. Anal fissures that last for six weeks or more are called chronic anal fissures. These fail conservative treatment and require a more aggressive, surgical approach.
Fissures are sometimes confused with hemorrhoids. Hemorrhoids are inflamed blood vessels in, or just outside, the anus. Both fissures and hemorrhoids often result from passing hard stool.
What are the symptoms of an anal fissure?
Symptoms of an anal fissure can include:
- Pain during and after a bowel movement
- Visible tear or cut in the area
- Bright red bleeding during or after a bowel movement.
Who is at risk for an anal fissure?
Certain factors raise the risk for anal fissures, including:
- Constipation with straining to pass hard stool
- Eating a low-fiber diet
- Intense diarrhea
- Any inflammatory condition of the anal area.
Anal fissures may also result from inflammatory bowel disease, surgery or other medical treatments that affect bowel movements or the anus.
How are anal fissures diagnosed?
Your child’s gastroenterologist will make a diagnosis based on:
- The child’s health history
- Description of symptoms
- Rectal exam.
Because other conditions can cause symptoms similar to an anal fissure, your child’s doctor might also order tests to find out whether there is blood in their stool.
How are anal fissures treated?
Treatments for anal fissures may include:
- Changing your child’s diet to increase fiber and water to help regulate his or her bowel movements and reduce both diarrhea and constipation. Learn more about adding fiber to your child’s diet.
- Taking warm baths for up to 20 minutes a day.
- Taking stool softeners, such as fiber supplements, as needed.
- Taking medications, such as nitrates or calcium blockers.
- Having surgery, such as a lateral internal sphincterectomy. This surgery releases pressure inside the anus, allowing more blood to flow through the area to heal and protect tissues.
What are complications of anal fissures?
Complications seen with anal fissures include:
- Pain and discomfort
- Reduced quality of life
- Difficulty with bowel movements, especially because many people avoid going to the bathroom because of the pain and discomfort it causes
- Possible recurrence even after treatment
- Clotting
- Uncontrolled bowel movements and gas.
How can I help my child live a better life with anal fissures?
If your child has an anal fissure, take these precautions to avoid making it worse and avoid recurrences:
- Give your child all medicines as prescribed.
- Be sure your child gets the recommended amount of fiber in his or her diet. Learn more about adding fiber to your child’s diet.
- Encourage the child to drink enough water to stay hydrated. Learn more about proper hydration.
- Help the child maintain a routine bowel habit. Your child’s health care team can help you come up with strategies for getting your child on track.
- Avoid giving the child spicy foods because they may make symptoms worse.
When should I call the doctor about my child’s anal fissure?
Contact your child’s provider if you notice blood in your child’s stool or if their bowel movements are so painful that they are avoiding going to the bathroom.