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An anal fissure is a linear tear in the skin of the distal anal canal below the dentate line. It is a common condition affecting all age groups but particularly common in young adults; men and women are equally affected. The classical symptoms are of anal pain during or after defaecation and the passage of bright red blood per anus. The pain is often severe and may last for a few minutes or for several hours after defaecation. Bleeding from an anal fissure is usually modest and any significant loss of fresh blood may be from another source such as haemorrhoids as these two conditions commonly co-exist. Pruritus ani may also accompany anal fissures. Symptoms from fissures cause considerable discomfort and reduction in quality of life.
On examination the fissure may be apparent as a linear or pear-shaped split in the lining of the distal anal canal as the buttocks are parted, but there is often marked spasm of the anal canal which obscures the view. The combination of spasm and pain often precludes a digital rectal or proctoscopic examination but a typical history supported by clinical findings of anal spasm makes the diagnosis of anal fissure highly likely. If visualized an acute fissure will have sharply demarcated fresh mucosal edges and there may be granulation tissue in its base. With increasing chronicity there is induration of the margins of the fissure and a distinct lack of granulation tissue; horizontal fibres of the internal sphincter muscle may be seen in the base of the mucosal defect and secondary changes such as a sentinel skin tag, hypertrophied anal papilla or a degree of anal stenosis may be present.
The majority of anal fissures are probably acute and resolve either spontaneously or with simple dietary modification to increase fibre and laxatives where appropriate. The distinction between acute and chronic fissures is an arbitrary one, but fissures failing to heal within 6 weeks despite straightforward measures are generally designated as “chronic”. Although a proportion (less than 10%) of these chronic fissures will eventually resolve with conservative measures, most will require further intervention in order to heal. Fissures are usually single and posterior midline fissures are most common, but 10% of women and 1% of men have fissures in the anterior midline. Women who develop symptoms after childbirth usually have anterior fissures. Multiple fissures or those in a lateral position on the anal margin raise suspicion as there may be underlying inflammatory bowel disease, syphilis, or immunosuppression including HIV infection. However, it is important to recognize that most fissures arising in patients with inflammatory bowel disease are posterior and are also painful in at least one half of cases. Similarly, fissures that are resistant to treatment should prompt further investigation.
Anal Fissure Treatment, Symptoms, Cream, Surgery & Diet
Anal fissure - NHS Choices
https://wikihomenutrition.com/home-remedies-anal-fissure/
https://patient.info/forums/discuss/how-to-cure-anal-fissure-quickly--270871
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anal-fissure
On examination the fissure may be apparent as a linear or pear-shaped split in the lining of the distal anal canal as the buttocks are parted, but there is often marked spasm of the anal canal which obscures the view. The combination of spasm and pain often precludes a digital rectal or proctoscopic examination but a typical history supported by clinical findings of anal spasm makes the diagnosis of anal fissure highly likely. If visualized an acute fissure will have sharply demarcated fresh mucosal edges and there may be granulation tissue in its base. With increasing chronicity there is induration of the margins of the fissure and a distinct lack of granulation tissue; horizontal fibres of the internal sphincter muscle may be seen in the base of the mucosal defect and secondary changes such as a sentinel skin tag, hypertrophied anal papilla or a degree of anal stenosis may be present.
The majority of anal fissures are probably acute and resolve either spontaneously or with simple dietary modification to increase fibre and laxatives where appropriate. The distinction between acute and chronic fissures is an arbitrary one, but fissures failing to heal within 6 weeks despite straightforward measures are generally designated as “chronic”. Although a proportion (less than 10%) of these chronic fissures will eventually resolve with conservative measures, most will require further intervention in order to heal. Fissures are usually single and posterior midline fissures are most common, but 10% of women and 1% of men have fissures in the anterior midline. Women who develop symptoms after childbirth usually have anterior fissures. Multiple fissures or those in a lateral position on the anal margin raise suspicion as there may be underlying inflammatory bowel disease, syphilis, or immunosuppression including HIV infection. However, it is important to recognize that most fissures arising in patients with inflammatory bowel disease are posterior and are also painful in at least one half of cases. Similarly, fissures that are resistant to treatment should prompt further investigation.
Anal Fissure Treatment, Symptoms, Cream, Surgery & Diet
Anal fissure - NHS Choices
https://wikihomenutrition.com/home-remedies-anal-fissure/
https://patient.info/forums/discuss/how-to-cure-anal-fissure-quickly--270871
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anal-fissure
