A tear in the anus or fissure in the anus is an annoying complaint. An anal fissure is an ulcerated fissure in the skin and/or mucous membrane of the anal canal. In most cases, an anal fissure is caused by hard stools due to constipation. Other causes are also possible. A tear in the anus or fissure in the anus can, for example, also be caused by prolonged diarrhea or by increased muscle tension, causing a disrupted blood supply around the anus. The fissure can cause complaints of pain during and after defecation, itching, burning sensation, and some (bright red) blood loss. The treatment focuses on facilitating bowel movements, reducing pain and removing increased tension in part of the sphincter.
Cracked anus, cracked anus
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- Anal fissure
- Painful anal fissure
- Chronic anal fissure
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- Causes: cracks or fissures in the anus
- Injury to the anal canal
- Underlying condition
- Vicious circle
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- Risk factors
- Symptoms
- Examination and diagnosis
- Interview and physical examination
- Follow-up research
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- Anal fissure treatment
- Treatment by the GP
- Surgical treatment
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- What can you do yourself?
- Preventing anal fissures
Anal fissure
Painful anal fissure
An anal fissure is a small and painful tear or fissure in the skin and/or mucous membrane of the anal canal. This lesion often runs longitudinally. An anal fissure is usually the result of constipation and passage of hard stools. A fissure near the anus often causes a sharp, cutting pain during or after bowel movements, often with some blood loss. Some bright red blood is then found on the stool or toilet paper.
Chronic anal fissure
An anal fissure usually heals within a few weeks after adequate treatment for constipation, but some fissures can become chronic. If an anal fissure will not heal, the patient will be referred for surgical treatment.
Causes: cracks or fissures in the anus
Injury to the anal canal
Injury to the anal canal causes an acute fissure. The main cause is persistent constipation, called constipation, often caused by eating low-fiber foods. Other causative factors reported in the literature include a previous bout of diarrhea or anal intercourse. It may also be related to increased tension, a kind of cramp in part of the sphincter muscle and therefore a disrupted blood supply.
Surgery or other medical treatments that affect bowel movements or the anus can also cause a fissure in the anus, as can minor trauma, especially an injury caused by cycling or mountain biking. Repeatedly rough or excessive wiping of the anus after defecating can also lead to anal fissures.
Underlying condition
Anal fissures can also occur with one of the following underlying conditions:
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- anal cancer;
- HIV;
- tuberculosis (TB);
- syphilis; and
- herpes.
Vicious circle
A vicious circle often arises because people unconsciously hold in stool due to the pain and increased tension in part of the sphincter muscle. However, this encourages hard stools and the fissure tears open again with each bowel movement. This causes the gap to persist. Breaking this pattern is no easy feat.
Risk factors
Factors that can increase the risk of developing an anal fissure include:
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- Childhood age. Many children suffer from anal fissure during their first year of life; experts don’t know exactly why that is.
- Older age. Older adults are more likely to develop a tear or fissure in the anus due to slowed or reduced blood circulation, resulting in reduced blood flow to the rectal area.
- Constipation. Straining during bowel movements and passing hard stools increases the risk of ruptures in the anus.
- Birth. Anal fissures are more common in women after they have given birth.
- Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, making the lining of the anal canal more susceptible to tearing.
- Anal sex. The anus is not designed for (unnatural) sexual penetration.
Symptoms
Symptoms of an anal fissure include:
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- Pain, sometimes severe, during defecation;
- Pain after bowel movements that can last up to several hours;
- Bright red blood on the stool or toilet paper after a bowel movement;
- Itching, irritation or burning sensation around the anus;
- A visible crack in the skin around the anus;
- A small bump on the skin near the anal fissure.
Examination and diagnosis
Interview and physical examination
When the patient reports to the doctor’s office, he will ask all kinds of questions about the duration of the pain complaints and the relationship with the stool, about the stool pattern (diarrhea and/or constipation), about additional complaints (blood loss, abdominal complaints) and to any previous anal pain complaints. The GP will also physically examine the patient and inspect the anus.
Follow-up research
The doctor may recommend further investigation if he or she thinks there is an underlying condition:
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- Sigmoidoscopy: a visual examination in which the last part of the large intestine is examined. The gastrointestinal specialist inserts a flexible tube with a camera into the intestine via the anus, the so-called endoscope. This test is used to look for early signs of cancer and can help the doctor diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus and (unexplained) weight loss.
- Colonoscopy: an internal examination of the large intestine, in which the inner lining or mucous membrane of the large intestine is viewed using an endoscope.
Anal fissure treatment
The treatment focuses on facilitating bowel movements, reducing pain and removing increased tension in part of the sphincter.
Your GP can prescribe cream or ointment for anal fissures / Source: Istock.com/Wavebreakmedia
Treatment by the GP
The doctor will advise the patient to eat fiber-rich foods and take regular warm sitz baths. This last measure is aimed at removing the increased tension in the sphincter. In addition to eating sufficient vegetable fiber, constipation complaints can be counteracted by taking a laxative, which ensures better passage of the stool. Stools can also be kept soft by drinking plenty of water. Pain can be combated by applying a thin layer of lidocaine cream before each bowel movement. This ointment must be prescribed by your doctor. Following the above-mentioned advice and measures, an acute anal fissure will heal in most cases.
Surgical treatment
Cracks that persist for more than three to four weeks can be treated with Isosorbide dinitrate Vaseline cream FNA. This is a vasodilator, which reduces pressure and dilates the blood vessels in the anus. This improves the blood supply at the location of the anal fissure. If healing has not been achieved after eight weeks, the treatment can either be extended for a few more weeks or the patient can be referred for outpatient surgical treatment. The GP will discuss these options with the patient.
Daily walking is healthy and good for bowel movements / Source: David Pereiras/Shutterstock
What can you do yourself?
Several lifestyle changes can help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrence:
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- Eat enough fiber and drink enough. Eating about 25 to 30 grams of fiber per day can help soften stools and promote healing. High-fiber foods include fruits, vegetables, nuts and whole grains. You can also take a fiber supplement. Adding fiber can cause gas and bloating. It is therefore wise to gradually increase fiber intake.
- Drink enough fluids. This prevents constipation.
- Exercise regularly. At least 5 times a week, but preferably daily, 30 minutes of moderately intensive activity, such as brisk walking or cycling, is recommended. This promotes regular bowel movements and increases blood flow to all parts of your body, which promotes healing of an anal fissure.
- Avoid straining during bowel movements. Straining creates pressure, which can reopen a healing anal fissure or lead to a new fissure.
- If your child has an anal fissure, it is a good idea to change diapers often, gently clean the anal area and discuss the problem with your doctor.
Preventing anal fissures
You can prevent an anal fissure by taking constipation prevention measures. Eat fiber-rich food, drink enough and exercise moderately for half an hour every day. This is good for bowel movements and prevents constipation.
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- Pain in the anus or anal pain: causes of painful anus