What are anal fissures?
An anal fissure is a crack or tear in the skin of the anal canal (the opening through which stool passes out of the body) that extends upwards into the anal canal. Fissures are a common condition of the anus and anal canal and are responsible for 6-15% of the visits to a colonic and rectal (colorectal) surgeon. They affect men and women equally and both the young and the old. Fissures usually cause pain during bowel movements that often is severe. Anal fissure is the most common cause of rectal bleeding in infancy.
What causes anal fissures?
Anal fissures are caused by trauma to the anus and anal canal. The cause of the trauma usually is a bowel movement, and many patients can remember the exact bowel movement during which their pain began. The fissure may be caused by a hard stool or repeated episodes of diarrhea. Occasionally, the insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland) can result in sufficient trauma to produce a fissure. During childbirth, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm.
What are the symptoms of anal fissure?
• Sharp, stinging or burning pain during and following a bowel movement.
• Spots of bright red blood on toilet tissue. This blood is separate from the stool. Blood mixed with the stool indicates some other conditions (like colon cancer and inflammatory bowel disease). Itching and malodorous discharge may also occur.
How are anal fissures diagnosed and evaluated?
A careful history usually suggests that an anal fissure is present, and gentle inspection of the anus can confirm the presence of a fissure. If gentle eversion (pulling apart) the edges of the anus by separating the buttocks do not reveal a fissure, a more vigorous examination following the application of an anesthetic to the anus and anal canal may be necessary.