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Anal Fissure (cont.)


Are Anal Fissures Painful (Symptoms and Signs)?

Severe pain during a bowel movement followed by continuing pain is the classic symptom of an anal fissure. There is a vicious cycle of constipation causing pain, which makes the anal sphincter muscles go into spasm. This causes more pain and spasms, which makes having a bowel movement more difficult and worsens the constipation. The pain is significant enough to make sitting down even more painful.

There also may be a few drops of bright red blood in the toilet bowel or when wiping, but significant bleeding usually doesn't occur.

When Should I Call a Doctor or Other Health Care Professional If I Think I Have a Fissure?

Blood in the stool is never normal and any bleeding should prompt a call to a health care practitioner. Bleeding from an anal fissure is minimal, and usually only a few drops of blood are seen in the toilet bowel or when wiping. The blood is not mixed in with the stool.

If there is significant amount of bleeding or if the patient complains of lightheadedness, shortness of breath, or abdominal pain, emergency medical services should be activated (call 911).

The pain of an anal fissure can be quite severe and it is reasonable to contact a care practitioner for advice about the diagnosis and options for pain relief.

Are There Tests to Diagnose the Condition?

The diagnosis of anal fissure is most commonly made after the health care practitioner takes a history of the patient's complaint and performs a physical examination. The history of constipation followed by a painful bowel movement and rectal that continues afterwards is often enough to make the preliminary diagnosis.

Physical examination is usually limited to inspection of the anus, looking for the crack or tear in the skin surrounding the anus. Because of the amount of pain and discomfort, the rectal examination, where a finger is inserted into the rectum to feel for abnormalities and to check for blood in the stool, is usually deferred.

If the fissure is not seen and there is doubt about the diagnosis, a flexible sigmoidoscopy may be considered, where the health care practitioner inserts a short lighted tube into the anus to inspect the area. Usually, lidocaine ointment is used as an anesthetic to make the procedure less uncomfortable.

No other blood tests or X-rays are needed.

Anal fissures that are due to constipation usually are found in the midline. If the fissure is located off to the side, other underlying medical conditions may be the cause, including Crohn's disease (a type of inflammatory bowel disease), HIV infection, and cancer.

Anal Fissure Home Treatment

Initial treatments for anal fissures that are often very successful are designed to make the stool softer, easier to pass, and prevent constipation. Drinking more fluids and eating a high fiber diet may be supplemented by stool softeners and bulking agents. Occasionally laxatives may be used to help promote a bowel movement but their long-term use is not always appropriate.

The second approach to treatment involves decreasing the anal sphincter spasm. Often all that is needed are regular Sitz baths, sitting in a warm tub of water that allows the muscle to relax. Ointments are available and may be prescribed to help decrease sphincter spasm if basic treatments fail.

Medically Reviewed by a Doctor on 9/11/2017
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