Anal fissure

What is an anal fissure?

An anal fissure is a tear in the delicate lining of the anus. It is often described as "acute" or present for less than 6 weeks, or "chronic" - present for six weeks or more. An anal fissure can cause great discomfort, even though it is often very small, because the area is very sensitive and the damaged tissue is stretched and disrupted every time the person needs to open their bowels.

Symptoms

If you have a fissure, passing bowel motions can be very uncomfortable. Bright red fresh blood will often appear in the toilet bowl or on toilet tissue, which can be alarming to discover. This blood comes from the torn lining tissues of the anus. The pain of passing motions often has a burning quality which can last for several hours before it eventually eases until the next time you open your bowels and stretch the damaged tissue again.
A vicious circle can develop as a person may become more reluctant to visit the toilet because of the pain, and then becomes more constipated. This is a particular problem when a child has an anal fissure.
It's important to note that passing blood in the motions can be a sign of cancer. If bleeding persists it should always be checked out and not just assumed to be the result of an anal fissure.

Causes and risk factors

It's thought that an anal fissure is usually caused by passing a hard, dry stool. So constipation, where the motions become hard and difficult to pass, is one of the most important causes. Dehydration can play a part too. However some people develop fissures without being constipated.
These initial factors then lead to increased tension or "tone" in the ring of muscle around the anus, which keeps it tightly, shut. Increased anal tone can reduce the blood supply to the anal tissues, impairing healing. The pain of the tear aggravates this process, increasing tone further and making the ischaemia worse.
Other causes of anal fissures include inflammation of the bowel, for example in Crohn's disease or severe gastroenteritis (which makes the lining of the anal canal more fragile), childbirth and tumours of the rectum and anus.

Treatment and recovery

The main aims are to promote healing and to resolve factors such as constipation which lead to the problem or will aggravate it.
For the pain, an anaesthetic cream or gel (available from the pharmacist) may help.
Taking a sitz bath (hip bath) is also recommended if you have the time. This involves sitting in a bath of warm water that covers the hips and buttocks a few times a day. This is soothing and helps to keep the area clean, which is very important.
To protect the fissure from clothes rubbing against it, use a barrier cream such as zinc and castor oil.
Deal with constipation naturally. Eating plenty of fibre from fruit, vegetables, wholemeal bread, breakfast cereals, dried figs and prunes, and drinking at least eight glasses of water a day, will keep bowel motions soft so further damage doesn't occur. Stool-softening treatments are also available from the pharmacist.
A prescribed cream containing glyceryl trinitrate (GTN) - a drug more commonly used to treat angina - is helpful when natural scarring and spasm prevent the fissure from healing properly. But 50 per cent of people whose fissure heals with this treatment will get a later recurrence of the problem.
Most anal fissures heal within one to two weeks. However some don’t, and instead go on to become chronic.
Then a simple operation may be needed. This might, for example, involve making a cut in the muscle around the anus in order to reduce the pressure on the tissues there. This is known as a lateral EE sphincterotomy. Most fissures heal within 2-4 weeks of this operation but in a few cases the problem recurs.
READMORE:http://www.bbc.co.uk/health