An anal fissure is a crack or tear in the skin of your anus that can affect people of any age. However, anal fissures are most common in middle-aged individuals, toddlers/infants, and women after childbirth. Pain before, during, or after a bowel movement is common.

For the most part, anal fissures aren’t a cause for concern and can be taken care of with some simple home remedies. There are also recurring fissures that don’t heal so easily. A visit to a doctor is recommended in such a scenario.

Causes of Anal Fissures

Trauma, specifically to the anus, is one of the leading causes of anal fissures. This can be due to one (or more) of the following reasons:

• Regular stretching, whether on its own or as part of a workout routine
• Anal sex
• Straining to initiate a bowel movement
• Chronic diarrhea
• Chronic constipation
• Insertion of objects into the anus

Aside from trauma, the following are some other causes.

• Anorectal scarring
• Excessively tight anal sphincter muscles*
  *Sphincter muscles control the opening and closing of the anus.
• Reduced blood flow to the anorectal region
• Poor bowel habits over a long period
• Some underlying medical conditions like anal cancer, ulcerative colitis (a kind of inflammatory bowel disease), Crohn’s disease, sexually transmitted problems (gonorrhea, syphilis, HIV, Chlamydia, etc.), tuberculosis, leukemia, etc.

Symptoms of Anal Fissures

You may be able to tell if you have an anal fissure if you notice one or more of the following symptoms:

• A distinct “crack” or “tear” in the skin around the anus
• Pain in and around the anus during bowel movements
• Itching and burning sensations in the anal area
• Blood in your stool
• A small lump of skin (also called a “skin tag”) next to the crack

How to Deal With an Anal Fissure?

The best thing to do is to see your doctor immediately. They would want to make sure the problem doesn’t indicate another disease with similar symptoms. These include infections, abscesses, hemorrhoids, inflamed skin tags, etc. Therefore, self-diagnosis is not the answer.

Once it’s conclusive that you have developed anal fissure(s), the treatment starts with some simple home fixes. You might have to make a couple of lifestyle changes in this regard. Conservative medical therapy is also an option.

Things to Do at Home

Soaking the bottom in warm water multiple times a day can work wonders for anal fissures. The pain felt by many individuals before, during, or after a bowel movement is usually due to muscle spasms. Anal fissures induce these spasms. You can relax those muscles by taking warm baths, which ultimately leads to healing the skin cracks in the anus over time.

Medical Therapy

Medical therapy also aims to relax and retrain the muscles. For this purpose, your doctor may recommend a specific cream or ointment to be applied to the anal region. They would help relieve tension from the muscles so the spasms can stop and the fissure(s) can heal. You can also use a numbing agent like lidocaine (with approval from a qualified medical practitioner). However, its side effects include more irritation and burning.

Other Non-Surgical Treatments

If you aren’t willing to go the surgery route or it isn’t an option because of any medical reasons, your doctor might recommend one of the following non-surgical treatments.

• Externally Applied Nitroglycerin
  Nitroglycerin is the go-to treatment for anal fissures when conservative medical therapy measures fail. This can improve blood flow to the region around the tear and promote healing by relaxing the anal sphincter. However, it has side effects, one of them being a severe headache.

• Botox Injection
  A Botox injection into the anal fissures will cause the anal sphincter muscle to paralyze temporarily. This will relax the spasms caused by the cracks and promote healing.

• Blood Pressure Medications
  Blood pressure medications like Cardizem and Procardia can also relieve tension from the anal sphincter. You can take them orally or apply them externally when treatments like nitroglycerin prove ineffective.

Surgical Options

In the event of conservative medical treatments proving futile, your doctor may recommend surgery. If you decide to go ahead with it, they will perform a Lateral Internal Sphincterotomy (LIS). The procedure will involve removing a small part of your anal sphincter muscle to prevent spasms and reduce pain. This will ultimately promote healing of the anal fissure.

Research indicates that surgery is much more effective in treating chronic anal fissures than conservative medical and non-surgical treatments. However, a surgical procedure like LSI brings a few risks with it. One of them is incontinence, a lack of control over defecation or urination.

Anal Fissure Diagnosis

Your doctor will probably perform a physical exam. This includes a gentle inspection of the anal region to find the crack(s) or tear(s). They are often visible prominently. Such an exam is normally all that’s required to find out if someone has anal fissures.

The location of an anal fissure may provide some idea about the underlying cause(s). For instance, a crack or tear on the side of the anal opening is probably a sign of Crohn’s disease. Your doctor may want to carry out some more tests in this scenario.

Takeaways and Prevention Strategies

Even though most acute fissures can be treated with simple home remedies, chronic fissures are more serious and need proper medical attention. Below are a few things you can do to prevent them from happening altogether.

For Infants

To prevent anal fissures in infants, you should:

• Change your little one’s diapers frequently
• Seek proper treatment for constipation

For Adults

On the other hand, adults should:

• Avoid irritating the rectum
• Maintain dryness of the anorectal area
• Immediately seek treatment for diarrhea and constipation
• Wipe your anal area with a cotton pad, moistened cloth, or some other soft material. Try not to use scented and rough-textured toilet paper

Before signing off, we would like to stress the need to seek qualified medical advice any time you feel strange pains in and around the anal area. The problem might not be very severe, but it never hurts to be careful!