Anal fissure

Anal fissures are breaks in the skin that lines the anal canal. They occur most commonly in young people, usually because of the passage of a hard stool that traumatizes the anus. Most patients who develop anal fissures have a higher-than-normal pressure in the anal canal. In a small percentage of cases, anal fissures stem from other causes, such Crohn's disease or certain infections.

• Sharp pain with passage of a hard or bulky stool. The pain may last up to an hour and returns with the next bowel movement.
• Pain when sitting on a hard surface.
• Streaks of blood on the toilet paper, underwear or diaper.
• Itching around the rectum.
• Children may refuse to have a bowel movement.

The exact cause is unknown, but the symptoms usually occur after the stretching of the anus from a large, hard stool.

• Constipation.
• Multiple pregnancies.
• Leukemia.
• Crohn's disease.
• Immunodeficiency disorders.

• Avoid constipation by:
  Drinking at least 8 glasses of water daily. Eating a diet high in fiber. Using stool softeners or other laxatives, if needed.
• Don't strain at stool.
• Avoid anal intercourse.

• Examination of the anus and rectum with an anoscope or sigmoidoscope to rule out other causes of anal or rectal bleeding.
• Gently clean the anus with soap and water after each bowel movement.
• To relieve muscle spasms and pain around the anus, apply a warm towel to the area.
• The therapy for anal fissures varies depending on how long the fissure has been present. Acute fissures are easier to heal because they have been present for a shorter length of time and have not yet caused a significant amount of inflammation in the surrounding tissues. The therapy for acute fissures includes sitz baths, suppositories and stool bulking agents to treat constipation. Topical nitroglycerin ointment can also provide a great deal of pain relief. With such treatments, acute fissures will heal in four to eight weeks in most patients.
• For fissures that do not heal, surgical therapy is often required. This procedure essentially involves a controlled disruption of the internal anal sphincter, thus leading to a lower pressure in the anal canal. It is felt that lowering this pressure will prevent further fissures from forming by improving blood flow to the anus. With surgery, the fissure typically heals in one to four weeks and remains healed in 95 percent of patients. The most common side effect of the procedure is minor fecal incontinence, affecting up to 15 percent of patients.

You or your child has symptoms of an anal fissure, especially pain that persists despite treatment.