Fissure (crack in the anus): tiny wound, great suffering
An anal fissure refers to a fissure or crack in the area surrounding the anus, resulting in discomfort, bleeding, and other bothersome symptoms. What are the factors that lead to the development of a fissure? Is it a condition that poses a significant risk? What are the available treatment options for managing a fissure? Is surgery required for the healing process, or can a fissure be effectively treated with home remedies?
Anal Fissure - In short
An anal fissure is a tear or rupture in the anal canal. It can cause severe pain and/or bleeding during bowel movements.
Among the factors that increase the risk of an anal fissure are constipation, pregnancy, and childbirth, straining during bowel movements, diarrhea, and inflammatory bowel diseases such as Crohn's disease.
The primary treatment for an anal fissure is based on increased water intake and dietary fiber, stool softeners, and sitz baths.
What is an anal fissure?
An anal fissure, also known as an anal tear or crack, occurs in the mucous membrane lining the anus. It can cause significant pain and/or bleeding when passing stool through the anus.
What is the difference between a fissure and hemorrhoids?
A fissure refers to a persistent crack in the rectal canal, whereas hemorrhoids are the enlargement of blood vessels in the same area. Due to similar causes, it is possible for patients to experience both conditions concurrently.
What causes fissures?
A fissure occurs due to a localized injury in the anus and anal canal. This injury leads to a tear that causes the rectal muscle to contract, resulting in reduced blood supply to the crack and delaying its healing process.
What are the risk factors for the development of an anal fissure?
Constipation.
Straining during bowel movements.
Diarrhea.
Pregnancy and childbirth.
Decreased blood flow to the area (common in older adults).
Inflammatory bowel diseases such as Crohn's disease and ulcerative colitis.
Anal sexual contact, the introduction of foreign objects.
Is fissure more common at a certain age?
While anal fissures can occur at any age, they are more commonly observed in younger adults and middle-aged individuals. However, they can also affect older adults, particularly due to factors such as decreased blood flow and age-related changes in the rectal tissues.
For unknown reasons, the phenomenon is very common in babies in the first year of life.
How is a fissure diagnosed?
Diagnosing the fissure is quite simple and is done through a physical examination and observation by a skilled doctor such as a surgeon or gastroenterologist.
Is fissure dangerous?
An anal fissure itself is not dangerous, but it can greatly affect the patient's quality of life.
However, it is important to know that very dark and hard stool or blood in the stool may be caused by other conditions that are not related to an anal fissure, such as inflammatory bowel disease, infections, or colorectal cancer. Therefore, it is important to consult a doctor in any case of blood in the stool.
How is a fissure treated?
In many cases, a fissure can be treated at home, without the need for hospitalization, and recover within days to a few weeks.
The basic treatment aims to soften the stools and regulate bowel movements to prevent further damage to the anal area. The treatment for an anal fissure is based on increased water intake, dietary fiber, stool softeners, and sitz baths (sitting in warm water for about 15 minutes with diluted water, 3-2 times a day, and after bowel movements). Such treatment may reduce the intensity of pain and stop the bleeding. The success rate of this treatment method is approximately 50%.
Topical creams - It is possible to add topical creams to the basic treatment that contain various active ingredients (such as Rectogesic or Nifedipine) with or without a local anesthetic.
These substances dilate blood vessels and relax the muscles surrounding the anal canal. Improvement is usually seen shortly after starting the treatment, but it is important to continue applying the cream daily for about two months. With proper treatment, success rates are around 65%. Possible side effects include headache, dizziness, and sudden drop in blood pressure.
Natural creams with no side effects - Natural creams often incorporate ingredients that have skin-softening properties, aiding in the healing of the fissure area. One such treatment is MUST Cream - a natural fissure remedy containing essential oils and plant extracts. Unlike other creams, MUST Cream not only softens the area but also expedites the healing process by promoting the restoration and recovery of skin cells in the affected area. Typically, the cream can heal the area within a few weeks.
MUST Cream formulation is primarily composed of pure essential oils, including juniper, lavender, and Licorice. MUST Cream is authorized by the Israeli Ministry of Health.
During fissure treatment, it is highly recommended to encourage soft stools to facilitate and accelerate the healing process. This can be achieved by following a diet rich in dietary fiber and maintaining proper hydration, particularly by drinking an ample amount of water. These measures increase stool volume and promote softer consistency. Additionally, increasing physical activity is advisable.
Botulinum toxin injection - Botulinum is a substance that temporarily relaxes muscles.
In the treatment of anal fissures, the medication is injected into the internal sphincter fibers, causing relaxation of the anal sphincter muscles. The medication reduces the pressure on the sphincter for a period of two to three months, allowing the fissure to heal. Reported success rates for a single injection are around 80%. Reported side effects include pain and infection at the injection site, minor bleeding, and temporary loss of control over gas. The medication should not be used during pregnancy or breastfeeding.
What do you do if the fissure treatments fail?
By adhering to our recommendations, we firmly believe that your fissure will heal. However, if the fissure does not show signs of improvement within six to seven weeks, it is often classified as chronic. In cases where a chronic fissure does not respond to conservative treatment, including ointments or botulinum injections, surgical intervention may be considered as a potential solution.
What are the types of surgery to treat fissures?
Lateral Internal Sphincterotomy - This surgery, which has success rates reaching 95%, is typically performed under general or spinal anesthesia (through the spinal cord). However, it can also be safely done under local anesthesia. Short post-operative monitoring is usually required.
The recovery is fast, and patients report a significant decrease in pain on the day following the surgery. In most cases, individuals can return to their regular routine within a few days.
Possible side effects: There have been reports of cases where the sphincter was affected, leading to temporary gas and stool incontinence after the surgery. However, the incidence of this complication is low, and it is often a transient phenomenon.
Fissurectomy - This procedure can be performed alone or in conjunction with a lateral sphincterotomy. In this process, the area of the fissure, where there is chronic inflammation, is excised, promoting healing of the surrounding healthy tissues.
Anal Dilatation - This is a manual or pneumatic expansion (using a balloon) of the anus. This is a procedure that is mostly uncontrolled and is not currently recommended for the treatment of fissures.
Flap Anoplasty - This is a procedure in which the sphincter muscle is detached from its original position and moved forward to cover the area of the fissure. It is a complex process mainly intended for cases where there is weak muscle tension in the sphincter.
How can fissures be prevented?
It is important to ensure regular bowel movements with a normal texture (formed stools) through increased fluid intake, a fiber-rich diet, and regular physical activity.
When it comes to infants, it is necessary to maintain dryness in the area of the sphincter by frequent diaper changes.
Maintaining anal hygiene is important: it is recommended to wash the area of the sphincter with lukewarm water and soap after each bowel movement (We recommend the Rambam handmade soap at the following link).
Treating a fissure at an early stage of its appearance is crucial.
Can a healed fissure reappear?
Studies show that the recurrence rates after surgery are the lowest compared to the other treatment methods, but the rate of complications, including incontinence, is higher.
To reduce the recurrence rate, it is recommended to adopt a healthy lifestyle that includes a diet rich in fiber such as fruits and vegetables, avoiding constipation and diarrhea and maintaining local hygiene.
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