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Anal Fissures: A Pain Nobody Wants To Discuss (And How To Treat It)

Anal fissures are both common and extremely painful. Despite any reluctance you may have discussing the issue with your doctor, the prognosis for a full recovery is much better if you seek early treatment. Learn more about this condition, and how it can be treated.

Diagnosis And Causes Of Anal Fissures

Anal fissures are small tears in the anus, and they cause a great deal of pain during bowel movements. After a bowel movement, anal fissures can cause agonizing spasms of the entire colon and rectal bleeding that can last hours. In between, the pain is minimal or non-existent. 

Fissures can be caused by just about any trauma to the delicate inner lining of anus, but there are some common causes. Patients who take opiates for chronic pain often suffer from anal fissures, because the opiates cause hard, dry bowel movements. However, fissures are equally as likely to occur in people who suffer from chronic diarrhea. Fissures are also common with people who have inflammatory conditions, like arthritis, Crohn's Disease, or diverticulitis as well.

A Cycle Of Damage

Many anal fissures heal on their own, but when they don't a painful cycle of injury and re-injury ensues. Every bowel movement after the one causing the initial fissure can tear open tissue that's barely begun to heal. The spasms that result reduce blood flow to the area, slowing healing even further. 

Unfortunately, there's no way to predict which fissures will heal on their own and which aren't. 

Home Treatment 

There are several conservative, non-invasive treatments that can be undertaken right away if you suspect an anal fissure, even before you see the doctor. These include:

  • a high fiber diet
  • high fiber supplements
  • hot baths after bowel movements
  • increasing water intake
  • topical pain relief creams

Some of the treatments are designed to keep bowel movements from being too hard or too loose, and softer, so that they don't tear delicate flesh. Others are designed at reducing pain, soothing sphincter muscles, and increasing circulation to promote healing.

Conservative Medical Care

If home treatment doesn't work, your doctor can prescribe a muscle relaxant cream, usually a nitroglycerin ointment, that can be applied around the anus, which can stop the painful spasms. 

Another, minimally invasive procedure, can also be tried: botulinum toxin (Botox) can be used to reduce the tension in the sphincter muscles around the tear.

Either way, the idea is to interrupt the spasm cycle that keeps reopening the fissure, increase blood flow to the wound, and promote healing.

Surgical Intervention 

If all else fails, a surgical intervention called a lateral internal sphincterotomy is sometimes necessary. The surgeon makes a small incision in the sphincter muscle to reduce the resting tension, which relieves the pull on the fissure and allows it to heal.

If you suffer from chronic anal fissures, and conservative treatment has failed, the lateral internal sphincterotomy offers the best chance of long-term healing. It's superior to treatment with ointments and Botox injections, because chronic fissures often return as soon as the ointments or injections are stopped. It offers real, long-term relief.

Surgery, however, isn't without risk: 9% of patients who undergo the procedure develop some long-term fecal incontinence.  

Because people are more familiar with hemorrhoids, it's common for people with anal fissures to misdiagnose their symptoms, further delaying treatment and risking chronic, long-term problems. However, hemorrhoids usually aren't extremely painful when you have a bowel movement. If you're suffering from pain and bleeding when you have a bowel movement, and suspect that you could have an anal fissure, discuss the situation with your rectal surgeon as soon as possible.