“It’s really painful, and people become almost afraid to go to the bathroom because of it,” Andrew Chun MD, FACG of the TriHealth Digestive Institute, explains.
What Causes Anal Fissures?
An anal fissure is a small split or tear that occurs in the lining of the anus. Anal fissures are common in young infants, but may occur at any age. These are typically categorized as acute (recent onset) or chronic (present over a long period of time, because they haven’t had a chance to heal).
Passing hard stools is the primary cause of anal fissures; however, other factors can make you more prone:
- Experiencing a difficult vaginal delivery
- Having certain diseases like Crohn’s disease, sarcoidosis, anal cancer
Anal Fissures: How Do I know if I Have One?
If you experience a tearing pain or bleeding with your bowel movements, schedule an appointment with your doctor.
From there, he or she will perform a rectal exam to examine the anal tissue. “If it’s an acute tear, you’ll see a cut there, but if you see heaped-up tissue, sometimes that’s a sign it’s a chronic issue and it’s been there a long time,” Dr. Chun explains.
Anal Fissures: 3 Ways to Treat Them
- Take Fiber Supplements: Once you’re diagnosed, your doctor will probably prescribe a conservative treatment, like dietary changes, which most people respond well to, Dr. Chun says. While he says it’s good to add fiber to your diet – to aid in digestion – you’ll need to take a fiber supplement, like Metamucil, which will soften the stool, making it easier to expel. “It’s actually fairly difficult to get enough fiber for therapeutic purposes from just what we eat,” he adds.
- Relax in a Sitz Bath: A sitz bath, which is a warm-water bath, right after you have a bowel movement helps cleanse the anal opening and relaxes the internal anal sphincter, which prevents the tissue from ripping more. This also helps keep the area clean and dry, helping the fissure heal.
- Nitroglycerin: If stool-softeners don’t fix your problem, your doctor may prescribe nitroglycerine ointment. “Nitroglycerine tends to cause a lot of headaches so we use .2 or .4% nitroglycerine ointment and we’ll put that on the anal area about four times a day,” Dr. Chun points out. The ointment alleviates pain by relaxing the internal anal sphincter muscle, one of the two muscles that control the anus, and increasing blood flow in the posterior area, which may help the fissure heal.
- Diltiazem: Diltiazem is a calcium channel blocker in ointment form that’s used to relax muscle spasms, allowing the fissure to heal. However, this medication is not as readily available because it needs to be made at a compounding pharmacy.
- Botox: As a less invasive option, Botox injections to both sides of the sphincter are usually effective. The only downside: The relief wears off and sometimes you need repeat treatments.
- A sphincterotomy: A sphincterotomy is a small, lateral cut on the side of the anal canal, usually as long and deep as the fissure itself. “That relieves the pressure almost instantaneously,” Dr. Chun explains. If you are interested in this procedure, you should be referred to a colorectal surgeon, and be aware that fecal incontinence can be a complication of the procedure; however, if this side effect does occur, it's usually minor.