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Understanding Anal Fissure: An Overview

An anal fissure (गुदा विदर) is a small tear in the thin, moist tissue (mucosa) that lines the anus. This common condition can cause pain and bleeding during bowel movements. Anal fissures are typically caused by trauma to the anal canal, such as passing large or hard stools. Still, they can also result from chronic diarrhea, anal sex, or conditions that cause inflammation in the anal region. Prompt medical attention and appropriate treatment are essential for effective management.

Continue reading to learn more about anal fissures, including symptoms, causes, diagnostic methods, prevention strategies, treatment options and more.

Disease Name:
Anal Fissure
Symptoms:

Pain during bowel movements, bleeding, itching, and a visible tear

Causes:

Passing large or hard stools, chronic diarrhea, constipation, anal sex, inflammatory conditions

Diagnosis:

Physical examination, Anoscopy

Treated By:

Colorectal Surgeon, Gastroenterologist, General Surgeon (Proctologist)

Treatment Options:

Medications, Botox injections, Lateral internal sphincterotomy, Anal dilation, Topical nitroglycerin, Calcium channel blockers

What are Anal Fissure?

An anal fissure is a small tear in the mucous membrane of the anal canal. This tear can be painful and may bleed, particularly during and following bowel movements. The anal canal is the last part of the digestive tract before waste is expelled from the body, and any tear in this sensitive area can lead to significant discomfort.

Anal fissures can be categorized based on their duration and severity:

  • Acute Fissures: These are recent and usually respond well to conservative treatments. They often heal within a few weeks with appropriate care.
  • Chronic Fissure: When an anal fissure persists for more than eight weeks, it is considered chronic. Chronic fissures can be more difficult to treat and may require more intensive medical interventions.

Types of Anal Fissures

Anal fistulas are abnormal passages that connect the inside of the anus to the skin around it. These painful and often recurring conditions can vary in complexity.

  • Posterior Fissures: These are the most common and occur at the back of the anal canal. They often result from trauma or straining.
  • Anterior Fissures: These occur at the front of the anal canal and are less common. They may be associated with specific conditions or traumas.

Symptoms of Anal Fissures

The symptoms of anal fissures can be distressing and may include:

  • Sharp Pain: This pain is often experienced during and after bowel movements. It can be severe and may last for hours.
  • Bleeding: Bright red blood may appear on the toilet paper or in the stool. This bleeding is usually minimal but can be concerning.
  • Itching and Irritation: The area around the fissure may become itchy and inflamed.
  • Visible Tear: A small tear or crack may be visible around the anal area.

Causes of Anal Fissures

Anal fissures typically result from various factors that stress or damage the anal canal. Common causes include:

  • Digestive System Disorders: Persistent diarrhea, chronic constipation, and inflammatory bowel diseases like ulcerative colitis (characterized by ulcers in the digestive tract) can contribute to the development of anal fissures.
  • Hard Stools: Passing large or hard stools can strain the anal canal and cause tears.
  • Sexually Transmitted Diseases (STDs): STDs such as syphilis, HIV, and herpes can spread to the anal area, causing irritation and fissures.
  • Anal Intercourse: This can lead to trauma and irritation in the anal region, increasing the risk of fissures.
  • Anal Cancer and Leukemia: These conditions can also contribute to the development of anal fissures.
  • Pregnancy and Childbirth: These take a heavy toll on the body and can even lead to constipation and increased pressure on the anal area.
  • Reduced Blood Flow: Pressure on the sphincter muscle can cause spasms and decrease blood flow to the anus, contributing to fissure formation.


While anal fissures can affect individuals of all genders and ages, it has a higher prevalence observed in children and adults between the ages of 10 and 30.

Diagnosis of Anal FIssure

To diagnose an anal fissure, your doctor will start by discussing your symptoms and bowel habits. A thorough rectal examination will be performed to identify any fissures. This may involve a visual inspection of the anal area or a gentle digital examination with a gloved finger. If you experience severe pain, be sure to inform your doctor, who may choose to forgo further examination to avoid exacerbating your discomfort. For a comprehensive assessment of anal conditions and to investigate the cause of anal bleeding, a proctoscopy may be recommended.

Treatment Options for Anal Fissures

Effective treatment for anal fissures aims to relieve symptoms, promote healing, and prevent recurrence. Options include:

Medications and Home Remedies:

  1. Pain Relief: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort.
  2. Dietary Changes: Increasing fiber intake, staying hydrated, and avoiding foods that cause constipation can help prevent and manage fissures.
  3. Topical Treatments: Creams and ointments containing numbing agents or corticosteroids can reduce pain and inflammation.
  4. Sitz Baths: Regular sitz baths in warm water can help soothe the affected area and promote healing.

Surgical Options:

  • Lateral Internal Sphincterotomy: This procedure involves making a small incision in the anal sphincter muscle to relieve pressure and promote healing of the fissure.
  • Anal Dilation: Involves stretching the anal canal to reduce pressure and aid healing. It’s less common and usually considered if other methods fail.

Non-Surgical Option:

  • Botulinum Toxin Injections: Botulinum toxin (Botox) can be injected into the anal sphincter to relax the muscle and facilitate healing of the fissure.

When to Consider Anal Fissure Surgery?

Surgical intervention for anal fissures is often considered in the following situations:

  • Persistent Symptoms: When symptoms do not improve with non-surgical treatments.
  • Chronic Fissures: For fissures that have not healed with conservative methods and have persisted for more than eight weeks.
  • Significant Impact on Quality of Life: When fissures significantly affect daily activities and overall comfort.

Cost of Anal Fissure

The cost of anal fistula surgery in India varies based on factors such as the type of procedure, the hospital or clinic, and the location. Below is a table outlining the approximate costs for different types of anal fistula surgery:

Lateral Internal Sphincterotomy

₹50,000 to ₹70,000*

Anal Dilation

₹30,000 to ₹50,000*

Botulinum Toxin Injection

₹20,000 to ₹35,000*

* T&C Apply

When to Consult a Doctor for Anal Fissures

If you experience any of the following symptoms, it’s important to seek medical advice:

  • Persistent or severe pain in the anal area.
  • Noticeable tears or cracks around the anus.
  • Ongoing or recurrent bleeding during bowel movements.
  • Discomfort or itching that doesn’t improve with home care.
  • Difficulty or pain during bowel movements.
  • Significant changes in bowel habits or stool consistency.

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Looking For Anal Fissure Treatment? Reach Out to the Experts at Cure Me

Anal fissures can cause considerable discomfort, but effective treatments are available to alleviate symptoms and enhance your quality of life. Early diagnosis and appropriate treatment are key to managing this condition and preventing recurrence. While conservative treatments and lifestyle changes can offer relief, surgical options may be necessary for persistent or chronic fissures.

Consulting with a specialist at Cure Me and exploring options for anal fissure treatment can lead to improved comfort and a more fulfilling life.

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