Understanding and Managing Anal Fissures: Essential Insights for Effective Treatment
Doctor explains how to identify, classify, and manage anal fissures—a common yet painful condition affecting many. Learn about symptoms, causes, treatment options, and when to seek further medical advice.
Disclaimer
The medical information in this content is for educational and entertainment purposes only. While Doctor O'Donovan Medical Education Limited always aims to provide accurate information, it does not replace professional medical advice from your own doctor or health provider. Always consult your own healthcare professional for medical concerns.
Doctor O'Donovan Medical Education Limited can not provide individual advice. Never ignore professional medical advice from your own health provider because of something you have read or watched here. Educational resources created by Doctor O'Donovan Medical Education Limited are not a substitute for professional medical advice, diagnosis or treatment.
Topic Breakdown
In today's blog post, we're diving deep into a topic that many might find uncomfortable to discuss but is crucial for understanding and managing—a condition known as anal fissures. An anal fissure is essentially a tear or ulcer in the lining of the anal canal, often causing significant pain during defecation. Imagine the rectum or the back passage, and picture a split or a line—this is what an anal fissure typically looks like.
First, let's talk about how we classify anal fissures. There are two primary ways to classify them: by duration and by cause.
**Classification by Duration:**
1. **Acute Anal Fissure:** This type has been present for less than six weeks. It's usually superficial with well-demarcated borders.
2. **Chronic Anal Fissure:** This type has been present for more than six weeks. It tends to be wider and deeper, and on clinical examination, you may even see muscle fibers at the base. The edges can often be swollen, and a skin tag might be visible at the end of the fissure.
**Classification by Cause:**
1. **Primary Anal Fissure:** This type has no clear underlying cause.
2. **Secondary Anal Fissure:** This type has a clear underlying cause, such as constipation, inflammatory bowel disease (IBD), sexually transmitted infections (STIs), or colorectal cancer.
**Who is Affected?**
Anal fissures are quite common, particularly affecting individuals aged 15 to 40. However, they can occur at any age. Primary anal fissures are uncommon in elderly people, and if they do occur, it warrants further investigation for an underlying cause.
**Symptoms and Signs:**
The primary symptom of an anal fissure is usually anal pain during defecation, which may or may not be accompanied by bright red bleeding and anal spasm. An external examination may reveal a linear split in the anal mucosa.
For acute anal fissures, the tear is usually superficial with well-demarcated borders. In contrast, chronic anal fissures are deeper and may expose muscle fibers, with swollen edges and possibly a visible skin tag at the end of the fissure.
**Position of Anal Fissures:**
Primary anal fissures typically occur in the posterior midline (around the six o'clock position), although 10% can occur in the anterior position (12 o'clock), especially in females. Secondary anal fissures, which have underlying causes like constipation or IBD, may present with irregular outlines, multiple fissures, or fissures in lateral positions (three o'clock or nine o'clock). In such cases, referral for examination under anesthesia may be necessary if the diagnosis is unclear or if anal spasm and pain make the diagnosis difficult.
**Treatment Options:**
Management of anal fissures involves several steps:
1. **Referral to Secondary Care:** If there is a suspected serious underlying cause like colorectal cancer.
2. **Dietary and Lifestyle Advice:** Ensuring the stools are soft and the passage of stools is easy. This includes a high-fiber diet, increased fluid intake, and good anal hygiene.
3. **Simple Analgesia:** Medications like paracetamol or ibuprofen can help manage the pain.
4. **Soaking in a Warm Bath:** This can provide relief from pain.
5. **Topical Anesthetic:** For adults with extreme pain during defecation, a short course of topical anesthetic can be considered.
6. **Rectal Ointment (e.g., Rectogesic):** For symptoms persisting for a week or more without improvement, a short six to eight-week course of rectal ointment can be considered.
For secondary anal fissures, it's crucial to manage the underlying cause or refer the patient to secondary care. If referring the patient, consider the clinical urgency, especially if colorectal cancer is suspected. In the UK, this would typically warrant a two-week wait referral.
For primary anal fissures, a review at six to eight weeks is recommended. If the fissure has healed, advise the patient to continue with dietary and lifestyle measures to reduce the risk of recurrence. If the fissure remains unhealed, referral to a general or colorectal surgeon is necessary. For children, specialist advice should be sought if an anal fissure hasn't healed after two weeks or sooner if there is significant pain.
I hope you found this discussion on anal fissures informative and useful. If you have any questions or comments, feel free to leave them below. While I strive to respond to every query, please note that this is an educational platform and I may not be able to provide individual clinical advice.
If you found this post helpful, consider booking a consultation to scale your medical brand on YouTube or sponsor our videos with your products. Your support helps us continue to provide valuable content for healthcare professionals and the general public alike.
Until next time, stay informed and take care of your health.
Share this article
Partner with Dr. O Donovan
If you would like to partner on a healthcare related campaign, discuss a story or seek my expert opinion please don't hesitate to reach out.