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Anal Fissure

Anal Fissure

Anal fissure, commonly known as a crack in the anus, refers to small tears or cracks in the skin around the anus. This condition is usually characterized by pain, bleeding, and discomfort, and can seriously affect quality of life. Although it is often associated with digestive system problems such as constipation or diarrhea, it can also arise from various other causes. Early diagnosis and appropriate treatment can help reduce symptoms and promote healing.

What is Anal Fissure?

An anal fissure is a superficial tear that occurs in the distal part of the anal canal, at the external opening of the anus. This area is a sensitive structure exposed to stretching and pressure during bowel movements. Although fissures usually form at a single point, in some cases multiple cracks may be observed. They are mainly classified into two types: acute and chronic.

Acute Anal Fissure: These are fissures that typically last less than 6 weeks and are more recently developed. They have a higher likelihood of responding to treatment.
Chronic Anal Fissure: These are fissures that last longer than 6 weeks and do not show signs of healing. In this type of fissure, scar tissue formation and deepening may occur, which can make treatment more complicated.

Mechanism of Anal Fissure Formation

Anal fissure most commonly occurs due to excessive stretching or trauma to the anal muscles during bowel movements. The main causes of this condition are as follows:

Constipation: Excessive pressure on the anal muscles during the passage of hard and dry stools.
Diarrhea: Frequent and watery bowel movements causing irritation in the anal area.
Childbirth: Perineal trauma experienced during delivery.
Inflammatory Bowel Diseases (IBD): Conditions such as Crohn’s disease can cause inflammation and ulceration in the anal area.
Other Rare Causes: Conditions such as sexually transmitted infections, tuberculosis, or cancer can also lead to anal fissures.

Symptoms of Anal Fissure

The symptoms of an anal fissure are usually quite pronounced and uncomfortable

Severe Pain: Sharp, burning, or stabbing pain that occurs during and after bowel movements. This pain may persist for several hours after defecation.
Rectal Bleeding: The presence of bright red blood on toilet paper or in the stool after a bowel movement. The bleeding is usually minimal.
Itching and Irritation: A constant itching sensation and irritation in the anal area.
Burning Sensation: A burning feeling in the area, especially after bowel movements.
Lump or Tag in the Anal Area: In chronic fissures, a small skin fold called a "sentinel pile" may form at the edge of the crack.
Fear of Defecation: Patients may avoid bowel movements due to pain, which can further worsen constipation.

If these symptoms are noticed, it is very important to consult a healthcare professional for accurate diagnosis and treatment.

Signs of Anal Fissure Healing

The healing process of an anal fissure may vary depending on the treatment method applied and the individual’s overall health condition. However, certain signs are observed when healing begins.

Symptom Condition Observed During Healing
Pain Reduction in the intensity of pain felt during and after bowel movements, and shortening of the duration of pain.
Bleeding Reduction in the amount of blood seen on toilet paper or in the stool, or complete cessation of bleeding.
Discomfort Reduction of itching, burning, and irritation sensations in the anal area.
Ease of Defecation The act of defecation becomes less painful and more comfortable, with a reduction in fear of bowel movements.
Appearance of the Area

Reduction of redness and swelling in the anal area, with the edges of the fissure beginning to close.

Treatment of Anal Fissure

The goal of anal fissure treatment is to reduce pain, facilitate easier bowel movements, and promote healing of the fissure. Treatment options vary depending on whether the fissure is acute or chronic and on its severity. Conservative (Non-Surgical) Treatment Methods:

Dietary Adjustment: Consuming high-fiber foods (fruits, vegetables, whole grains) and drinking adequate amounts of water softens the stool and prevents constipation.
Warm Sitz Baths: Sitting in warm water for 15–20 minutes, 2–3 times a day, relaxes the anal muscles, increases blood flow, and relieves pain.
Laxatives: Stool softening medications facilitate bowel movements and reduce pressure on the fissure.
Topical Creams and Ointments: Creams containing nitrates or calcium channel blockers that relax the muscles in the anal area and increase blood flow can be used. These creams help the fissure heal. Pain-relieving and local anesthetic creams also alleviate symptoms.
Botulinum Toxin (Botox) Injection: In chronic fissures, botox is injected into the anal sphincter muscle to temporarily relax the muscle. This reduces muscle spasm, increases blood flow, and promotes healing.

Surgical Treatment Methods

Surgical options may be considered in anal fissures that do not respond to conservative treatments or have become chronic.

Lateral Internal Sphincterotomy (LIS): This is the most commonly performed surgical method. Muscle spasm is relieved by cutting a small portion of the anal sphincter muscle. This procedure permanently relaxes the muscle, allowing the fissure to heal. It has a high success rate and is generally a minimally invasive method.
Fissurectomy: Although rare, surgical removal of the fissure and surrounding scar tissue may be necessary. This method is usually performed alongside LIS or in cases where LIS has failed.

The treatment option should be determined based on the patient’s condition and the doctor’s evaluation.

Rectal Bleeding

Rectal bleeding, the presence of blood from the anus, can be a symptom of various digestive system disorders, and anal fissure is one of these causes. The color and amount of bleeding can provide clues about its source. Characteristics of Bleeding Related to Anal Fissure:

Color: It is usually bright red. This indicates that the bleeding originates from the lower gastrointestinal tract around the anus.
Amount: Usually small in quantity, it can be seen as wiping on toilet paper or as streaks on the surface of the stool. It may drip in drops or fall into the toilet bowl.
Timing: It usually occurs during or immediately after bowel movements.
Accompanying Symptoms: Bleeding is often accompanied by severe pain, which is a typical feature of anal fissure.

The treatment option should be determined based on the patient’s condition and the doctor’s assessment.

Frequently Asked Questions (FAQ)

Acute anal fissures usually heal on their own with appropriate lifestyle changes (high-fiber diet, adequate water intake) and simple home treatments (warm sitz baths). However, chronic fissures or cases with severe symptoms require medical intervention. Untreated chronic fissures can lead to more serious problems.

The recovery time after anal fissure surgery (especially lateral internal sphincterotomy – LIS) is generally short. Most patients can return to their daily activities within a few days. Complete healing and full resolution of pain may take several weeks. Following the doctor’s recommendations, paying attention to nutrition, and preventing constipation are very important during the healing process.

Yes, anal fissures can recur. Especially if underlying causes (such as chronic constipation or diarrhea) are not corrected or lifestyle changes are not maintained, there is a risk of fissures recurring. Even after surgery, recurrence can rarely occur. To prevent recurring fissures, it is important to maintain a proper diet and regular bowel habits.

For anal fissure, consultation with general surgery specialists is recommended. General surgeons who specialize in proctology (colorectal surgery) have experience in the diagnosis and treatment of such conditions.

Here are some home practices you can do to relieve anal fissure symptoms and speed up healing: High-Fiber Diet: Soften your stool by consuming fruits, vegetables, and whole grains. Adequate Water Intake: Drink at least 8-10 glasses of water daily to prevent your stool from becoming dry and hard. Warm Sitz Baths: Sit in a bathtub filled with warm water for 15–20 minutes, 2–3 times a day. This relaxes the anal muscles and relieves pain. Use of Laxatives (Under Doctor’s Supervision): Stool softeners reduce constipation and ease straining during bowel movements. Pain Relievers: You can achieve symptomatic relief with painkillers recommended by your doctor. Remember, these methods only help alleviate symptoms and do not replace medical treatment. If symptoms persist or worsen, be sure to consult a specialist.

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