Anal Fissure
An anal fissure is a tear or ulcer in the lining of the anus.
Anal fissures may be caused by an injury from a hard or large bowel movement. Uncommonly, they may also be caused by penetration of the anus during anal sex. Fissures cause the anal sphincter to go into spasm, which prevents healing.
Fissures cause pain and bleeding, usually during or shortly after a bowel movement. The pain lasts for several minutes to several hours and then subsides until the next bowel movement. A doctor diagnoses a fissure by inspecting the anus.
Treatment
A stool softener or psyllium may reduce the possibility of reinjury by hard bowel movements, while lubricating and soothing the lower rectum. Lubricant suppositories also can be helpful. A warm sitz bath for 10 to 15 minutes after each bowel movement eases discomfort and helps increase blood flow, which promotes healing.
Promising experimental treatments have been developed to reduce sphincter spasm and promote healing of fissures, including injection of the sphincter with toxins from Clostridium botulinum bacteria and application of nitroglycerin ointment or calcium channel blockers to the area of the fissure.
When these measures fail, surgery may be needed. Sphincter spasm can be relieved either by stretching (dilating) the anus or by cutting the internal sphincter (internal anal sphincterotomy).
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