The anal fissure is a condition that generates a lot of discomfort and, in addition, it is still treated as a taboo. However, knowing the symptoms and knowing when it is time to seek an appointment is essential to properly treat the condition and avoid discomfort and complications.
The anal fissure is characterized by a small cut or crack in the lining of the anus , which causes pain and / or bleeding during bowel movements. This is a common and self-diagnosis condition in most cases.
Symptoms may present in acute or chronic conditions. In the first case, the cure takes place in the short term (four to six weeks) with the help of some care at home. In situations of chronic anal fissure, medical treatment or even surgery may be necessary.
What is the relationship between constipation and anal fissure?
People who suffer from constipation or constipation are more likely to develop the disease. This is because hard or very large stools at the time of evacuation can cause trauma to the mucous membrane of the anus, resulting in an anal fissure.
Types of anal fissure
The factors that differentiate the types of anal fissures are basically the healing time of the wound and the evolution of the condition.
Here are the types of the disease:
Acute anal fissure
These cases are the most common and can develop at any age. To be considered acute, the anal fissure is represented by a superficial cut and painful to the touch. Its healing usually occurs in a maximum of eight weeks.
Chronic anal fissure
In chronic cases, the fissure becomes an ulcer that can be easily observed by the doctor. The lesion appears to be deep and with hardened edges. There is also the appearance of sentinel plicoma (excess skin in the anal area) and, in some cases, papillitis (inflammation of glands in the anal canal).
Chronic anal fissure pictures have a long history and longer evolution time.
What are the causes of anal fissure?
Anal fissures are caused by trauma to the anus or anal lining and usually occur in a bowel movement.
In men and women, the wounds are usually located on the posterior midline of the anal canal, the part closest to the spine. This is due to the configuration of the muscle that surrounds the anus (anal sphincter).
Because it has an oval shape, the posterior part of this muscle complex is more fragile. The wounds located on the anterior part usually occur in women due to the location of the vagina – in men, the probability is only 1%.
The most common causes of the disease are:
- Constipation (constipation) or tension during evacuation;
- Evacuation of hard and very large stools;
- Frequent diarrhea;
- Insertion of rectal thermometer, enema tip, endoscope or ultrasound probe (for examination of the prostate);
- Anal sex;
- Inflammation of the rectal area, caused by Crohn’s disease or another inflammatory bowel disease such as ulcerative colitis;
- Stress during childbirth – trauma to the skin between the vagina and the anus (perineum) can cause a fissure;
- Postoperative of surgeries of the anal region (hemorrhoids, fistulas, etc.).
If the wound is located in a region other than the posterior or anterior midline, it is possible that the cause of the disease is related to another problem.
In more rare cases, the wound may be due to:
- Sexually transmitted diseases (syphilis, herpes, AIDS, soft cancer, etc.);
- Cancer of the anal canal.
Groups of risk
There are some groups more likely to develop anal fissure. Are they:
- Children (especially during the first year of life);
- Elderly (older adults have a slower circulation, which results in a decrease in blood flow to the rectal area);
- People suffering from constipation (constipation causes the stools to harden, which can cause trauma to the lining of the anus);
- Parturients (stress during childbirth can cause anal fissures);
- People with Crohn’s disease (inflammation of the intestinal lining makes the tissue around the anus more likely to tear).
Symptoms: how to detect anal fissure?
The main symptoms of the disease are pain and bleeding . It is common for the patient to complain of severe pain during and after evacuation. In addition, blood may also appear on the toilet or toilet paper.
Other symptoms of anal fissure are:
- Anal discomfort when sitting;
- Itching and burning after evacuation;
- Small crack visible in the skin around the anus;
- Itching or irritation around the anus;
- A small lump or skin mark around the fissure;
- Anal itching.
Bleeding from an anal fissure has a bright red appearance. If the blood color is darker and mixed with feces, the problem can be considered more serious. Seek medical help immediately.
What is the difference between hemorrhoids and anal fissures?
Some symptoms of anal fissure can easily be mistaken for hemorrhoids . But despite the two diseases manifesting in the anal canal, there are conditions that can differentiate them.
First, you need to understand what hemorrhoids are: dilated blood vessels located in the lining of the anus. The anal fissure, on the other hand, is a crack in the skin tissue in the region. Both pathologies can cause bleeding and pain in the bowel movement, but cases of recurrent pain are usually chronic anal fissures.
Other anorectal conditions such as pruritus, abscess and fistula may have similar symptoms. The best way to differentiate them is through physical examination. Therefore, seek medical help for a correct diagnosis and treatment.
When should I see a doctor?
Seek medical help whenever you experience pain or bleeding during or after a bowel movement. Even if the healing of the fissure happens spontaneously, it is important to seek guidance if the symptoms persist.
How is the diagnosis of anal fissure made?
The diagnosis of the disease can be made by analyzing the symptoms and observing the area around the anus, since the cut or crack is, most of the time, visible. In some cases, the doctor may order a rectal exam to confirm the diagnosis. However, this method can be avoided as it is very painful for the patient in some situations.
From the location of the fissure, the doctor can find the possible causes of the disease. If the crack appears next to the anal opening, there is a greater chance that the patient has an underlying condition. In that case, the professional may request the following exams:
- Colonoscopy: test that inserts a flexible tube in the rectum to inspect the colon and check for the presence of inflammatory bowel disease, such as Crohn’s disease.
- Sigmoidoscopy: exam that inserts a thin and flexible tube through the rectum, to analyze the lower part of the colon.
- Upper Gastrointestinal (UGI): X-ray test used to examine the upper and middle sections of the gastrointestinal tract.
- Anorectal electromanometry: exam that analyzes the functioning of the muscles around the anus, used to assist the diagnosis of anal fissure as a manifestation of inflammatory disease.
Is anal fissure curable? How to treat?
The anal fissure is a treatable disease, which tends to disappear on its own in a period of four to six weeks. In most cases (acute anal fissures), treatment is done without the need for surgical intervention.
Initially, the treatment is done in a clinical way with the help of some homemade methods:
- Sitz bath with warm water;
- Adjustment of the diet with greater fiber and fluid intake;
- Temporal consumption of laxatives (under medical recommendation);
It is also possible that the specialist recommends the application of an injectable anesthetic to the rectal area to facilitate healing. These conservative methods usually have a 90% cure rate.
As a last resort, botox injections can be applied to temporarily paralyze the muscles in the region. However, it is worth mentioning that this method presents faecal incontinence as the most common complication.
How to make sitz bath for anal fissure
To make a sitz bath you will need:
- Bathtub, shallow basin or toilet seat;
- Warm water (temperature between 30 and 40º C);
- Salt or baking soda (optional – check with your doctor).
Follow the steps below:
1 – Fill the bathtub, basin or toilet seat with warm water and add salt or baking soda if applicable. The amount of water should be sufficient to cover the buttocks and hips.
2 – Fit the container over the toilet bowl to make it more comfortable. If it is not possible, place it on the floor.
3 – Sit with your legs out and your feet flat on the floor. Stay in this position for 15 to 30 minutes.
4 – When finishing the sitz bath, dry the area by tapping it with a clean cotton towel.
This procedure can be done 2 to 4 times a day.
Anal fissure surgery is called anal sphincterotomy. This procedure consists of cutting a small portion of the anal lining muscle, in order to reduce spasm and pain, and to promote healing.
According to studies, surgical treatment is much more effective than any other. On the other hand, this surgery can lead to fecal incontinence and lead to the inability to control the outflow of gases , mild fecal escape and even loss of solid stools.
In what cases is surgery necessary?
In cases of chronic anal fissure, in which there was no healing after clinical treatment, surgery can be recommended.
When the patient suffers from other anal diseases, such as hemorrhoids, there is also the possibility of indication for surgical treatment.
What is the best medicine for anal fissure?
Some types of medication are usually combined with anesthetic creams to facilitate healing and decrease pain, they are:
- Steroids: help to reduce inflammation and are recommended especially before a bowel movement.
- Nitroglycerin: causes relaxation of the internal anal sphincter and decreases the anal resting pressure.
- Calcium channel blockers: help to relax the muscles of the internal sphincter and increase blood flow in the anal area.
There may also be the prescription of laxatives to favor the elimination of feces and analgesics (such as Paracetamol and Ibuprofen ), in cases of prolonged pain.
Remedy for inflamed anal fissure
A part of the pictures of anal fissure can evolve to an inflammatory state, triggering a small local bump on the outer edge of the anus, called the sentinel plicoma. This, in general, can even be confused with a hemorrhoid.
The condition can be treated with common anal fissure medications, as well as complementary treatments, but it must be evaluated individually.
In addition, local inflammation can often occur due to infection of the anal fissure. These cases can develop into an anal abscess, which has pus. These cases usually require medical evaluation for the prescription of antibiotics and other specific medications.
How to treat anal fissure with ointments?
The ointments commonly indicated by specialists for the treatment of cracks are:
- Ultraproct ;
Ointments with healing properties such as Bepanthene, Bepantol or Hipoglós can also be used in the treatment.
Check out some tips and measures to relieve the symptoms of the disease and accelerate the healing process.
- Insert fiber in your diet! Foods such as fruits, vegetables and whole grains help to regulate the bowel and prevent constipation. The recommended daily fiber intake is between 20 and 40 grams.
- Drink a lot of water! Together with the fibers, hydration helps to soften the stool. The ideal is to drink between 1.5 to 2 liters of water per day.
- Do not force evacuation and do not be in a hurry to evacuate! The strain can cause new cracks. Increase the amount of fibers and liquids to facilitate evacuation.
- Exercise regularly! A few minutes of activity every day helps to promote bowel movements and increase blood flow in all parts of the body.
- Replace toilet paper with wet wipes! Scarves are less aggressive to injured skin.
In some situations, the patient may have:
- Failure of healing (anal fissures that are not cured within six weeks are considered chronic, which may result in the need for surgical intervention);
- Recurrence (when developing an anal fissure, the chance of having the disease again is greater);
- Extension of the wound to the adjacent muscles (this makes the fissure more difficult to heal, which can trigger a cycle of discomfort and the need for surgery).
Can anal fissures cause colon cancer?
Anal fissures do not increase the risk or cause colon cancer . However, some similar symptoms of the disease can be caused by more serious conditions. For this reason, cases of rectal bleeding should be well investigated.
How to prevent anal fissure?
To decrease the risk of the disease, you should avoid triggering factors, such as constipation (constipation). Some habits and behaviors can help:
Eat a balanced, fiber-rich diet
Since fibers help to regulate the intestine and are the best way to prevent constipation, it is important that they are present in your diet regularly.
Avoid fried foods and high-fat foods
The fat present in food makes digestion difficult and tends to cause the feeling of a heavy stomach. Fried foods are low in fiber and high in fats, so they should also be avoided.
Avoid excess sugar and sodium in your diet
Soft drinks (in all versions), syrups, crackers and cookies should be avoided. These foods are usually high in sugar and / or sodium and can impair bowel function.
Drink a lot of water
Drinking 1.5 to 2 liters of water per day along with fiber intake allows the stools to become more bulky and less hard. This will facilitate the evacuation process.
The amount of water recommended per day depends on some factors, such as: level of physical activity, weight, metabolism, diet, alcohol consumption. Consult your doctor for a correct assessment.
Consume yogurt daily
Yogurts contain health-beneficial probiotic bacteria that act on the balance of intestinal flora and dysfunctions, such as diarrhea and constipation. It is important that consumption is made together with fibers so that the effect of both is enhanced.
Chew your food properly
When chewing food slowly, digestion and absorption of nutrients is favored. This causes food to reach the stomach and, subsequently, the intestine more lightly. This habit can prevent the appearance of several disorders such as gas and abdominal discomfort.
Practice exercises regularly
Bowel movements are favored when we practice physical activity regularly. Exercising for 30 minutes a day can keep your bowels going and prevent constipation.
Treat a case of diarrhea immediately
Cases of prolonged diarrhea can promote irritation or damage to the anal mucosa. This facilitates the appearance of cracks. Other anorectal injuries such as hemorrhoids can also cause the disease.
Keep the anal area dry
Try to keep the area of the anus always clean and dry. This recommendation is important, as it helps to prevent the appearance of other anorectal disorders. Use a piece of cotton to avoid moisture and avoid using rough towels.
Anal fissure in children
To prevent the appearance of wounds in babies, change your diapers regularly. This process will help to keep the region clean and dry, in addition to preventing diaper rash.
A balanced diet combined with regular physical activity can reduce the risk of developing anal fissure. Always try to maintain healthy habits and, in the event of the onset of the disease, follow the treatment correctly.
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