Anal fissure

From Wikipedia, the free encyclopedia

**Anal fissure**
*Classifications and external resources*
ICD-10	K 60.0-K 60.2
ICD-9	565.0
DiseasesDB	673
MedlinePlus	001130
eMedicine	med/3532 ped/2938 emerg/495

An anal fissure is an unnatural crack or tear in the anus, usually extending from the anal opening and located posteriorly in the midline. This location is probably because of the relatively unsupported nature of the rectal wall in that location.

1 Causes
2 Symptoms
3 Prevention
4 Treatment
5 Footnotes
6 External links

[edit] Causes

Most anal fissures are caused by stretching of the anal mucosa beyond its capability. Various causes of this fissure include:

Straining to defecate, especially if the stool is hard and dry
Severe and chronic constipation
Severe and chronic diarrhea
Crohn's disease and Ulcerative colitis
Anal sex or dildo use
Anal stretching
Insertion of foreign objects into the anus
Tight sphincter muscles
Excessive anal probing

Anal fissures are common in women after childbirth,<ref>Abramowitz L, Sobhani I, Benifla J, Vuagnat A, Daraï E, Mignon M, Madelenat P (2002). "Anal fissure and thrombosed external hemorrhoids before and after delivery.". Dis Colon Rectum 45 (5): 650-5. PMID 12004215.</ref> and following constipation in infants<ref>Martínez-Costa C, Palao Ortuño M, Alfaro Ponce B, Núñez Gómez F, Martínez-Rodríguez L, Ferré Franch I, Brines Solanes J (2005). "[Functional constipation: prospective study and treatment response]". An Pediatr (Barc) 63 (5): 418-25. PMID 16266617.</ref>.

[edit] Symptoms

The symptoms of anal fissure include:

Pain during, and even hours after, defecation
Visible tear in the anus
Blood on the stool or on toilet paper or toilet bowl
Constipation
Burning, possibly painful, itch

[edit] Prevention

In infants under one year old, frequent diaper change can prevent anal fissure. For adults, the following can help prevent fissure:

Treating constipation by eating food rich in dietary fiber, avoiding caffeine (which can cause dehydration), drinking a lot of water and taking stool softener
Treating diarrhea promptly
Lubricating the anal canal with petroleum jelly
Avoiding straining or prolonged sitting on the toilet
Using a moist wipe instead of perfumed and harsh toilet paper.
Keeping the anus dry and hygienic.

[edit] Treatment

Most anal fissures are shallow or superficial (less than a quarter of inch or 0.64 cm deep). These fissures self-heal within a couple of weeks. While waiting for the fissure to heal, topical or suppository containing anti-inflammatory agents and local anaesthetic can be used. Furthermore, treatment used for hemorrhoid such as eating a high-fiber diet, using stool softener, taking pain killer and having a sitting bath can help.

Anal fissures in infants usually self-heal without anything more than frequently changing diapers and treating constipation if the cause.

Painful deep fissures, on the other hand cut through the sphincter muscle thus making it prone to spasm, which exacerbates the fissure and aborts the healing process. Medications such as nitroglycerine<ref>Simpson J, Lund J, Thompson R, Kapila L, Scholefield J (2003). "The use of glyceryl trinitrate (GTN) in the treatment of chronic anal fissure in children.". Med Sci Monit 9 (10): PI123-6. PMID 14523338.</ref> and nifedipine ointments can relax the sphincter muscle, thus allowing the healing to proceed. Botulinum toxin injection can also be used to relax the sphincter muscle.

Surgical intervention may be required for persisting deep anal fissures unresponsive to the above conservative measures. Procedures include:

Internal lateral sphincterotomy or excising a portion of the sphincter
Anal dilation or stretching of the anal canal is no longer recommended because of the unacceptably high incidence of fecal incontinence

Despite the high success rate of these surgical procedures (~95%), there are potential side effects, which include: risks from anesthesia, infection, anal leakage or fecal incontinence.