Anal fissures are a common but often misunderstood medical condition that affects people of all ages. Despite being a frequent source of discomfort, fissures are relatively straightforward to treat when identified early. This guide offers an in-depth overview of what fissures look like, what causes them, what do fissures look like, and the best approaches for treatment and prevention.
Table of Contents
What Is an Anal Fissure?
What Do Anal Fissures Look Like?
Symptoms of Anal Fissures
Causes of Anal Fissures
Diagnosing Anal Fissures
Treatment Options for Anal Fissures
Preventing Anal Fissures
When to Seek Medical Help
What Is an Anal Fissure?
An anal fissure is a small tear or cut in the skin lining the anus. This tear can develop due to various factors, including chronic constipation, frequent diarrhea, and even childbirth. Anal fissures are usually located at the edge of the anus, where stool exits the body, and can range in severity from minor to more extensive, deeper tears.
Though generally harmless, fissures can cause significant discomfort, especially during bowel movements. If left untreated, they may become chronic or lead to complications such as infections. Thankfully, most fissures heal on their own with time and proper care.
What Do Anal Fissures Look Like?
Appearance of Acute Fissures
In the early stages, anal fissures often appear as small, superficial cuts or tears at the opening of the anus. These acute fissures tend to look like:
A thin, red or pink line: This line may be visible near the anal opening and will often look similar to a paper cut.
Bright red blood: The tear may bleed, causing visible blood on toilet paper after wiping. Fresh blood is often bright red, which distinguishes it from other rectal bleeding sources.
Slight swelling or irritation: The skin around the fissure may appear inflamed, swollen, or irritated.
Chronic Fissures
If left untreated, a fissure can develop into a chronic fissure, which looks somewhat different and has its own set of characteristics:
Larger tear with raised edges: Chronic fissures tend to deepen over time, with slightly raised or thickened edges surrounding the tear.
Skin tag: Chronic fissures often develop a small skin tag, also known as a “sentinel pile,” near the tear. This tag is a result of the body’s reaction to the persistent irritation and serves as a protective mechanism.
Deeper redness or even white scar tissue: As fissures become chronic, they may develop white scar tissue, which makes the tear appear paler.
Symptoms of Anal Fissures
Beyond the visual appearance, fissures have symptoms that can signal their presence, including:
Sharp pain during bowel movements: This is one of the most common and prominent symptoms of an anal fissure. The pain is typically intense at the time of passing stool and can continue for several minutes to hours afterward.
Itching or burning sensation: Many people with fissures experience persistent itching or a burning sensation around the anal area.
Bleeding: Anal fissures often cause bleeding, usually characterized by bright red streaks on toilet paper or in the toilet bowl.
Muscle spasms: The anal sphincter may go into spasm due to the irritation caused by the fissure, which can increase pain and delay healing.
Causes of Anal Fissures
Anal fissures can result from various factors that place undue strain on the delicate skin around the anus. Common causes include:
Constipation: Straining to pass hard stools is the most common cause of anal fissures. The pressure and friction can cause the skin to tear.
Diarrhea: Chronic diarrhea can irritate the anal canal, leading to fissures over time.
Childbirth: The pressure exerted during childbirth can lead to fissures in some women, particularly if labor is prolonged or involves excessive straining.
Underlying health conditions: Certain medical conditions, such as Crohn’s disease, inflammatory bowel disease (IBD), and chronic hemorrhoids, increase the risk of developing fissures.
Injury: Occasionally, trauma to the anal area, such as from rough wiping or inserting objects, can cause fissures.
Diagnosing Anal Fissures
Anal fissures are typically diagnosed through a physical examination. A doctor, often a general practitioner or gastroenterologist, will examine the affected area visually. If the fissure is deep or chronic, additional diagnostic tests might be recommended to rule out other conditions.
Physical examination: A simple visual examination is often enough for diagnosis, as fissures are visible around the anal opening.
Anoscopy: In some cases, an anoscope (a small, tube-like instrument) is used to examine the anal canal. This procedure allows the doctor to assess the fissure’s size, location, and depth.
Additional tests: If a patient experiences chronic fissures or has underlying health concerns, tests like colonoscopy may be used to rule out other bowel or rectal issues.
Treatment Options for Anal Fissures
Treatment for anal fissures typically starts with conservative methods. Most acute fissures heal on their own within a few weeks with simple treatments, but chronic fissures may require more advanced therapies.
Home Remedies for Acute Fissures
Fiber-rich diet: A diet high in fiber helps soften stools, making bowel movements easier and reducing strain on the anal area.
Hydration: Drinking adequate water helps prevent constipation and maintains bowel regularity.
Sitz baths: Soaking the anal area in warm water for 10–15 minutes several times a day can help reduce pain, increase blood flow, and relax the anal sphincter, aiding healing.
Topical pain relievers: Over-the-counter creams containing lidocaine can provide temporary pain relief.
Avoiding straining: Practicing proper toilet habits, like not holding the breath or forcing a bowel movement, can help prevent further irritation.
Medical Treatments for Chronic Fissures
If a fissure becomes chronic, additional treatments may be required:
Topical medications:
Nitroglycerin ointment: This prescription ointment helps relax the anal muscles, increasing blood flow to the area and promoting healing.
Calcium channel blockers: Creams containing calcium channel blockers like diltiazem can also relax the muscles and reduce pain, assisting in healing.
Botox injections: In some cases, Botox injections can relax the anal sphincter muscles, reducing spasms and allowing the fissure to heal.
Surgery (lateral internal sphincterotomy): If non-surgical methods fail, surgery may be necessary. This involves making a small incision in the anal sphincter to relieve tension, promoting healing. Surgery is usually very effective, with a high success rate.
Preventing Anal Fissures
Preventing anal fissures largely revolves around maintaining healthy bowel habits and taking steps to avoid constipation.
Tips for Fissure Prevention
Eat a high-fiber diet: Incorporate plenty of fruits, vegetables, whole grains, and legumes to ensure soft stools.
Stay hydrated: Drinking at least 6–8 glasses of water a day is essential for regular bowel movements.
Exercise regularly: Physical activity can help prevent constipation by stimulating digestion.
Avoid straining: If possible, relax and take your time when using the restroom to avoid straining.
Maintain good hygiene: Clean the anal area gently with mild soap and water, avoiding aggressive wiping that can irritate the skin.
When to Seek Medical Help
While many anal fissures heal independently, some cases require medical attention. See a healthcare provider if you experience:
Persistent pain or discomfort that doesn’t improve within a week or two.
Chronic bleeding: If you notice regular or heavy bleeding, seek medical assistance.
Recurring fissures: If you’ve had multiple fissures or fissures that keep coming back, there may be an underlying condition that needs treatment.
Signs of infection: Symptoms like increased redness, swelling, warmth, or discharge around the fissure may indicate an infection.
Conclusion
Anal fissures, though often uncomfortable, are typically a minor condition that responds well to conservative treatments. Recognizing the appearance of a fissure can aid in quick identification and early treatment, often preventing the condition from becoming chronic. By understanding what fissures look like, their symptoms, causes, and available treatment options, individuals can take steps to manage and prevent this condition effectively. However, if pain or bleeding persists, consulting a healthcare provider is essential for accurate diagnosis and long-term relief.
Anal fissures are a common yet manageable concern; with the right lifestyle adjustments and medical guidance, most people can overcome this condition and improve their overall quality of life.