 |
|
|
|||||||||||||||||||||||||||||||||||||||||||
 |
 |
|
|||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Anal fissureThis factsheet is for people who have been diagnosed with an anal fissure and those who would like information about it. An anal fissure is a small tear in the skin around the opening of the anus. It can cause sharp pain, especially when opening the bowels and for an hour or so after. Anal fissure is thought to be a common disorder for which many people do not seek medical advice. It can be easily confused with haemorrhoids (piles). For more information about piles please see the separate BUPA factsheet, Piles (haemorrhoids). About anal fissuresAnal fissure is a common condition that can affect people of all ages. Most anal fissures are at the rear of the anal opening - in line with the cleft of the buttocks. A fissure can also occasionally be to the front of the anus, especially just after childbirth.
SymptomsSymptoms of an anal fissure include:
Acute and chronic anal fissuresAnal fissures can be "acute" or "chronic". An acute anal fissure is one that heals quite quickly - within six weeks. An acute fissure looks like a fresh tear in the skin. A chronic anal fissure is one that has failed to heal for some time and lasts for more than six weeks. If you have a chronic fissure, the edges of the tear will be thickened. If you are examined by your GP, he or she may be able to see the white fibres of the internal anal sphincter at the base of the tear. What causes anal fissures?Often, no cause is found for an anal fissure. However, it is commonly linked to constipation, where straining on hard stools can tear the skin of the anus. The internal anal sphincter is thought to play a key role in the development of an anal fissure. This is one of two muscles that control the opening of the anus. Both muscles need to relax in order to pass a stool. Unlike the exterior anal sphincter, which can be tensed or relaxed voluntarily, there is no voluntary control of the internal sphincter. Because of the pain of a fissure, the internal anal sphincter may go into spasm - causing a raised pressure within the anus. This excess pressure makes it harder to pass a stool, making constipation worse, and contributing to a vicious circle. The spasm of the internal anal sphincter can also restrict the blood supply to the anal skin, which reduces its ability to heal. Anal fissures are also common after childbirth and bouts of diarrhoea. DiagnosisIf your symptoms do not improve within a couple of weeks, it is worth seeing your GP for advice and to rule out other conditions. Your doctor will ask you about your symptoms including your bowel habit. He or she may also examine the anal area. TreatmentAcute anal fissureChanges to your diet will help the anal fissure to heal. The main aim is to try and avoid constipation, so that stools are smaller and softer.
It may help to use a lubricant such as petroleum jelly in the anal area before a bowel motion. To relieve discomfort, sitting in a warm bath after using the toilet may relieve the spasm. If the fissure has still not healed despite these home treatments, or if you are worried about it, you should see your doctor. You should also see a doctor if you have blood within your stool (rather than some spotting on toilet paper or in the bowel) or have recently experienced altered bowel habits or have been losing weight, as another problem may be responsible for your symptoms. Drug treatments that your GP may prescribe include the following.
These treatments will help to relieve the spasm of an anal fissure. Your doctor may prescribe these in conjunction with advice about avoiding constipation and, possibly, laxatives. Chronic anal fissureTreatments for chronic anal fissure aim to reduce spasms and reduce the pressure in the anal canal. As well as advising the measures above for acute anal fissure your GP may prescribe glyceryl trinitrate (Rectogesic), a rectal ointment. It works by relaxing the muscle of the internal anal sphincter. This reduces the spasm and improves the blood flow to the anus, helping the fissure heal. Using the ointment may mean you can avoid more invasive treatment such as surgery. A number of other medical approaches to anal fissure are sometimes used. For example, some specialists use an injection of botulinum A toxin (Botox) to temporarily paralyse part of the sphincter. This reduces spasm and therefore the pressure in the anus which can improve blood flow. So far, studies of botulinum A toxin treatment have produced mixed results and more research is needed. Botulinum A toxin injections are not currently licensed in the UK for anal fissure but can be prescribed by doctors for "off-label" use. Ask your doctor for more information about drug treatments. SurgeryThe aim of surgery is similar to that of medicines - to relieve the excessive pressure within the anal canal. This can be done by cutting the internal anal sphincter in an operation called a lateral sphincterotomy. An anal dilation procedure to stretch the sphincter is another option. The anal stretch procedure is rarely done as there is a high risk of faecal incontinence and tears of the anal sphincter. PreventionThe best way to avoid getting an anal fissure is to avoid getting constipated. See Treatments above. Further information
Sources
Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP. partner/principal general practitioner at Rowcroft Medical Centre. Published by BUPA's health information team, healthinfo@bupa.com, September 2006.
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
![Print-friendly version [opens in a new window]](/images/icons/icn_printer.gif){kind=icon}
|
|
|
||||
 |
 |
|||||
| ||||||
 |
 |
|
 |
|
|