Anal fissures

What is it about ?

An anal fissure is a small crevice in the skin around the anus. Anal fissures are painful and bothersome, but do not pose any risk. Usually they go away spontaneously.

The crack is usually located on the back edge of the anus (80% of cases). It is here in the anus that the blood circulates less well.

Causes of anal fissures

• Usually, anal fissures occur when the anus opens too suddenly. In case of constipation and hard stools, you may be pushing so hard that the skin around the anus tears.
• Anal fissure can also occur with diarrhea. A small skin lesion appears when you wipe your anus too often.
• the anal sex can also cause anal fissures.
• A condition can also be at the origin of the problem, such as Crohn’s disease or a tumor, although this is rare.

How to recognize them?

The main symptoms of anal fissures are pain and the blood loss.

• The pain occurs during bowel movements or immediately after using the toilet, and can be particularly severe.
• the blood originates from the wound and is visible in the stool or on toilet paper after wiping yourself.

How is the diagnosis made?

Discussion

The doctor will ask questions about your stool :

• How often do you have a bowel movement?
• Are your stools hard or soft?
• Do you feel the pain during defecation?
• Do you see blood in the stool?

Anal exam

Anal fissure is usually easy to diagnose, but the doctor will often perform a anal exam to analyze the pressure exerted on the sphincter muscles and to exclude other causes. The presence of the crack may make this examination slightly painful.

What can you do ?

Since most cracks are due to constipation, it is recommended first of all to try to soften your stool. To do this, you can adapt your diet or take a mild laxative.

From hot sitz baths (40 ° C), twice a week for a quarter of an hour, will relax the sphincter and relieve the pain.

What can your doctor do?

An anal fissure heals spontaneously in 60 to 80% of cases. In addition to measures to soften stools and hot sitz baths, a numbing cream to be applied topically before and after defecation can also relieve pain.

If the complaints have not gone away after a month and spontaneous recovery seems unlikely, the doctor may also prescribe other ointments to heal cracks. It is recommended to apply it three times a day for about eight weeks.

Chronic crack

If the crack has still not healed after 2 months or if it reappears regularly, it is called a chronic crack.

• In this case, you must first try a treatment with a ointment. The latter will have an effect in 50% of cases.
• From botox injections sometimes contribute to healing.
• A surgery can also be considered. In this case, the doctor will refer you to a specialist. During the procedure, a small incision is made in the sphincter to reduce the pressure in the muscle. The intervention does not treat the crack as such, but it acts on the mechanism which is at the origin of the crack.
• For larger lesions that do not heal, a skin graft may be exceptionally necessary.

Want to know more?

• Constipation – Christian Mutuality

Source

Foreign clinical practice guide ‘Anal fissure’ (2000), updated on 03/28/2017 and adapted to the Belgian context on 03/21/2019 – ebpracticenet