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anal drift
Anal fissure: A guide to symptoms, causes, and relief
An anal fissure (medically known as an anal fissure) is a small tear or sore in the sensitive skin around the anus. Although an anal fissure is harmless, it is notorious for causing very severe pain, which often feels out of proportion to the size of the wound.
If you experience pain when going to the toilet, it is important to know that there are effective treatments for anal fissures that can quickly reduce your discomfort.
What does anal fissure feel like?
The symptoms of an anal fissure are very specific and differ from those of hemorrhoids, for example:
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Pain during bowel movements: It often feels like you are "pooping glass."
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After-pain: A dull, aching pain or cramping sensation in the rectum that can last for several hours after going to the bathroom.
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Blood on the paper: You will typically see fresh bleeding as a small streak of bright red blood on the toilet paper.
Why do people get anal fissures?
The primary cause of an anal fissure is mechanical overload of the skin. This most often occurs when:
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Constipation: Hard stools stretch and tear the skin.
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Severe diarrhea: Frequent trips to the toilet can irritate and dry out the mucous membrane.
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Tight sphincter muscle: If the sphincter muscle is very tight, blood flow is reduced, making the skin vulnerable and preventing an existing anal fissure from healing.
Treatment of anal fissures: How to get rid of the pain
The goal of treatment is to break the vicious cycle of pain and cramping.
Home treatment and prevention
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Stool softening: It is essential that stools are soft, like toothpaste. A high-fiber diet and plenty of water are crucial.
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Warm sitz baths: A lukewarm bath can help relax the sphincter muscle and relieve acute pain after using the toilet.
Medical treatment
The most effective treatment for anal fissures is prescription ointment (e.g., Rectogesic or Diltiazem). The ointment helps the sphincter muscle relax so that blood can flow freely to the wound, which is necessary for your anal fissure to heal.
Botox and surgery
If the ointment does not work after 6-8 weeks, Botox injections can be administered into the sphincter muscle or minor surgery can be performed to remove scar tissue and release the tension.
References (PubMed-based)
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Nelson, R. L., et al. (2012). “Non surgical therapy for anal fissure.” PubMed PMID: 22336814. Reviews the evidence for why medical treatment should be the first choice for anal fissures. Link to PubMed
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Tanderup, C., et al. (2015). “Botulinum toxin for anal fissure.” PubMed PMID: 25776361. Danish-related research into the use of Botox for the treatment of anal fissures. Link to PubMed
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Madalinski, M. H. (2011). “Pharmacological management of anal fissure.” PubMed PMID: 21626245. A technical review of how different ointments work on an anal fissure. Link to PubMed