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Dermatology Information and Resources

Fissures

A Fissure is a small tear in the opening or tissue lining of the anus. Fissures are common among all age groups and are often mistaken for hemorrhoids. Two types of anal fissures exist: Acute, which last for a temporary period (up to 12-weeks) and heal on its own with self care measures, and Chronic, lasting a longer duration or reappearing frequently.[1]

Common symptoms:  Fissures can cause sharp pain and bleeding during and after bowel movements. Similar to hemorrhoids, seeing bright red blood on toilet tissue after wiping is common.[2] Pain can last up to several hours after a bowel movement, and the tear in anal lining or small lump can be felt at the site. Fissures can make bowel movements very painful and uncomfortable, making sufferers afraid to defecate.

Causes: Fissures are caused by trauma to the anus, with the most common cause being the passing of hard stools. Constipation or diarrhea, straining on the toilet, anal intercourse, and even childbirth are also common causes. Less common causes are Crohn’s disease, HIV, anal cancer, tuberculosis, or syphillis.

Treatment: Fissures are commonly misdiagnosed as hemorrhoids by medical practitioners since both have similar symptoms. Pain in an acute fissure can be alleviated by softening the stool with a high-fiber diet (or fiber supplements), and by drinking plenty of water.[3] OTC Lidocane is a useful topical anesthetic that can be directly applied to the site to relieve pain and promote healing.[4] Using opioids to deal with pain is not recommended by medical professionals since constipation is a common side-effect.

In the case of anal intercourse, is critical in allowing an anal fissure to heal. Avoiding penetration will not only speed up healing, it will ensure that further diseases can’t be transmitted through tears in the skin.

Chronic fissures may require prescription-strength options such as nitroglycerin ointment which relaxes the internal anal sphincter muscle, increasing blood flow to the injury site, accelerating the healing of the fissure. Calcium channel blockers including diltiazam and nifedipine can also be prescribed to heal chronic anal fissures.

Surgical options for treating anal fissures include Botulinum toxin (Botox®) injection and surgical lateral internal sphincterotomy).  Both of these options promote relaxation of the anal sphincter, to decrease anal pain and spasm, allowing the fissure to heal.[5]

 
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References

[1] https://www.fascrs.org/patients/disease-condition/anal-fissure-expanded-information
[2] https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424
[3] https://www.webmd.com/digestive-disorders/anal-fissure-treatment#1
[4] https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430
[5] https://www.fascrs.org/patients/disease-condition/anal-fissure-expanded-information