An anal fissure is a tear in the thin mucosal tissue that lines the rectum. Fissures occur most often in infants and toddlers due to straining associated with difficult to pass, hard stools but can occur in all populations. Other people that are more at risk of developing fissures are the elderly, post-partum women, and those with constipation-predominant IBS.

SYMPTOMS

Symptoms of a fissure may include:

  • Bleeding during bowel movements
  • Pain during bowel movements
  • Spasms in the anal sphincter

Fissures are also strongly associated with constipation and pelvic floor disorders like anismus because people who have fissures often delay bowel movements in anticipation of pain and discomfort. Fissures can develop because of dehydration, which leads to constipation and hard stool that’s difficult to pass. Subsequent bowel movements become painful because of the fissure, so people are more likely to hold stool in, leading to a vicious cycle of harder, more painful stools, which can ultimately cause pelvic floor disorders.

CAUSES

A difficult to pass, hard stool that requires straining is the most common cause of anal fissures. Other factors that make an individual more susceptible to developing a fissure include:

  • Slow circulation seen with aging, which decreases blood flow to the rectum
  • Constipation
  • Dehydration
  • A low-fiber diet
  • Inflammation in the digestive tract, making the lining more prone to tearing
  • Childbirth
  • Previous fissures

DIAGNOSIS

A rectal exam (doctor inserts a finger into the rectum to feel for physical manifestations) as well as physical inspection of the anal area is the best way to detect and diagnose an anal fissure, as it can be felt and seen by the naked eye. Fissures can be a sign of other digestive conditions, such as Crohn’s disease, and health history and symptoms are important in determining your risk for these conditions. 

TREATMENT

Preventing constipation and encouraging regular bowel movements are important steps in treating a fissure. The longer stool remains in the colon the harder it becomes and the more difficult it is to pass.

If you have a fissure, creating stool that is soft enough so it’s easy to pass is very important in not only allowing your fissure to heal, but also in preventing future fissures from re-occurring. Increasing dietary fiber, psyllium husk powder (or capsules), and drinking more water are all helpful in creating soft, easy to pass stools.

Fissures are strongly associated with constipation and pelvic floor disorders like anismus because people who have fissures often delay bowel movements in anticipation of pain and discomfort.

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