You just got up from the toilet and feel pain radiating from your anus. There is no reason to be concerned– it could just be an anal fissure. Fissures, like hemorrhoids, are one of the most common medical conditions of the anorectal region.
According to WikiDoc, the incidence of fissures in the U.S is roughly 1100 per 100,000 individuals, and about 235,000 new cases are reported each year.
Although some individuals are at a higher risk of developing fissures, they can affect all age groups and genders. Incidence is higher in patients with Crohn's Disease, middle-aged people, and teens. A research paper published on NCBI stated that the incidence of anal fissures in women is higher than in men.
Now that we have a little background on the demographics, let's discuss what fissures are. Once we establish that, we will move on to talk about their symptoms and causes.
What are Anal fissures?
An anal fissure is described as a tear or laceration in the soft mucosal lining of the anus or rectal region. It starts as a small tear and is generally present on the skin that lines the opening of the anus. The American Society of Colon and Rectal Surgeons (ASCRS) explains that almost all fissures occur on the midline of the anus, either in the back or the front. Fissures located on the sides can be signs of other diseases.
Anal fissures can be divided into chronic fissures or acute fissures, depending on the duration of the symptoms. Acute fissures are freshly developed and do not cause much discomfort. If left untreated, they develop into painful chronic fissures which require immediate medical attention.
In the case of chronic fissures, it is ill-advised not to seek medical assistance since they can give rise to dangerous complications affecting the anorectal region.
They can further be divided into primary and secondary fissures. Depending on the location of occurrence, they are also divided into posterior (backside) and anterior (front side) fissures.
Now we know how to describe anal fissures, let’s talk about the symptoms. How can you tell whether you have them or not?
Symptoms of Anal fissures
Anal fissures can be extremely painful right from the beginning, so it's relatively easy to identify them. One of the most common symptoms of fissures is pain during or after a bowel movement.
An individual with anal fissures can almost immediately experience pain during a bowel movement; it can last up to several hours after a bowel movement. Spasmodic throbbing pain and spasms of the anal sphincter are also unique to anal fissures; the sphincter is the muscle of the anus that controls the passing of stool.
Another often overlooked symptom is rectal bleeding. Bright red blood during or after bowel movements can also be a potential indicator of anal fissures. One of the rarer symptoms can include discomfort when urinating. Some patients also experience frequent urination or the inability to urinate.
Patients suffering from chronic fissures sometimes experience a foul-smelling discharge from the anus. Constant sharp, burning pain or itching after bowel movements are also signs of anal fissures. It is important to note that, unlike other anorectal conditions, patients with fissures often don’t experience symptoms in-between bowel movements since the pain occurs from passing stool.
Some patients complain about constipation, while others experience watery diarrhea. Visual indicators include cracks or tears on the skin of the anus or the rectal region. These can be fresh and shallow cuts or deep lacerations with visible scar tissue.
Extra tissue growth can also be observed in the case of chronic fissures. The reason for this is hypertrophied papilla, which can develop as a direct result of untreated chronic fissures. Another associated symptom is the presence of skin tags or a sentinel pile which is an external lump on the outside of the anus.
We have covered the known possible symptoms of fissures. The abovementioned symptoms include those common to all fissures and some that are rare occurrences but can be observed nonetheless. In any case, giving your doctor a visit for a proper diagnosis is of the utmost importance.
Causes of Fissures
So far, we've discussed the classification and symptoms of fissures. Let's conclude by understanding what causes them in the first place.
The primary cause of fissures is trauma to the inner lining of the anus. Strenuous bowel movements mainly cause this; hard, dry bowel movements can increase friction against the anus or rectal region walls and cause tears. However, this does not rule out soft or loose stools and diarrhea, also known contributors to fissures.
Anal intercourse can also cause fissures. Compared to the vaginal canal, it is not naturally lubricated, and trauma from anal intercourse and passing large or hard stools can cause tears and lacerations on the lining of the anus. Some other common causes also include childbirth and chronic diarrhea.
As we discussed at the beginning of this article, patients with Crohn's disease are more likely to develop fissures. Although not common, people suffering from anal or colorectal cancer, HIV, tuberculosis, and syphilis can also likely develop anal fissures.
Various inflammatory bowel diseases and cirrhosis of the liver due to alcoholism are also among the known causes.
This is all of the information we compiled on anal fissures from various reputed sources on the internet. We hope this article helped you better understand this condition, its symptoms, and its causes!