Main
- Anal fissure — a tear in the mucous membrane of the anus, manifested by pain during defecation and blood on the paper.
- Causes: constipation or hard stool, prolonged diarrhoea, straining, childbirth, inflammatory bowel diseases, reduced blood supply.
- Symptoms: pain lasting from several minutes to hours, bright red blood, itching or burning, sphincter spasm, a feeling of incomplete emptying.
- Diagnosis: examination of the perianal area, digital rectal examination, anoscopy, rectoscopy, blood tests.
- Managed by a proctologist, and in their absence — by a surgeon or coloproctologist; care includes a fibre-rich diet, sitz baths and minimally invasive procedures.
What is an anal fissure
An anal fissure is a small tear or ulcer on the mucous membrane of the anus that appears after the passage of hard stool. Below is an explanation of what exactly happens with such damage, what circumstances cause it, and who is affected by it more often.
What happens in the body
The mucous membrane of the anus is covered with a thin layer of tissue that is easily damaged when stretched. When hard or large stool passes through the narrow canal, the surface layer of the mucous membrane tears, and a small wound forms on it. The edges of such a tear separate with each subsequent bowel movement, so it does not have time to heal on its own. Due to the constant tension of the tissues and muscle spasm in this area, blood flow in the small vessels slows down. The spasm occurs as a response of the muscle to pain, but it also compresses the edges of the damage and prevents them from healing together. The person feels sharp pain during defecation and notices traces of blood on the paper. If the tension and hard stool recur, the tear deepens and turns into a long-healing ulcer. When such pain and traces of blood appear, it is worth seeing a proctologist so that the damage does not become chronic.
What causes it to develop
- Constipation or hard stool: dense faecal masses stretch the mucous membrane more than it can withstand and tear its surface.
- Prolonged diarrhoea: frequent loose bowel movements irritate and soften the tissue, causing it to lose strength and become more easily injured.
- Straining during defecation: strong tension increases pressure in the anus and creates additional stress on its walls.
- Vaginal childbirth: pushing and the passage of the baby stretch and compress the tissues in the perineal area, damaging the mucous membrane.
- Inflammatory bowel diseases: constant inflammation weakens the mucous membrane, and it becomes damaged even with normal stool.
- Reduced blood supply in the anal area: with insufficient blood, the tissue recovers less well, so even a small tear takes a long time to heal.
Who encounters this more often
This condition is more common in adults whose stool is regularly hard or infrequent. Constipation is often accompanied by a sedentary lifestyle and a lack of fluid and fibre in the diet. In women, the damage more often occurs after vaginal childbirth, when the tissues of the perineum experience strong stretching. In people with inflammatory bowel diseases, the mucous membrane is constantly weakened, so tears appear more easily and last longer. With age, the blood supply to the tissues in this area deteriorates, and healing is slower. In children, the damage is usually associated with hard stool and temporary constipation, but it occurs less often than in adults. If the stool remains hard, the tear recurs and becomes chronic, so getting the bowels working properly is no less important than treating the wound itself.
What symptoms can occur?
An anal fissure manifests primarily as pain in the anal area, which occurs during or immediately after a bowel movement. Other signs can also raise suspicion of it, and in certain conditions help is needed without delay.
How it is noticed at the very beginning
At the very beginning, an anal fissure most often makes itself known by sharp pain in the anal area during or immediately after a bowel movement. The pain may last from a few minutes to several hours, and then subsides until the next bowel movement. Because of this rhythm, a person often attributes the discomfort to fatigue, heavy food or accidental straining. Along with the pain, there is bright red blood on the toilet paper or on the stool itself, and this trace is easily mistaken for irritation. Sometimes instead of pain, itching or burning in the anus is troubling, and then the cause is sought in something completely different. Gradually, a spasm of the anal sphincter muscles appears, because of which bowel movements become painful and tense. If such signs recur time after time, it is worth booking a routine appointment with a proctologist, without waiting for the pain to worsen.
Signs that occur most often
- Pain during or after a bowel movement: the main sign, which may last from a few minutes to several hours and subside until the next bowel movement.
- Bright red blood: traces on toilet paper or on the stool, which are important to distinguish from other sources of bleeding.
- Itching or burning: unpleasant sensations in the anus, which are often attributed to irritation or an accidental dietary slip.
- Spasm of the anal sphincter: tension of the muscles, because of which bowel movements become painful and maintain the discomfort.
- Feeling of incomplete emptying: a sensation remains that the bowel has not emptied completely, and this makes you strain again.
- Combination of signs: if pain, blood and spasm recur together, this is a reason to book a routine appointment with a proctologist rather than wait.
When to seek help urgently
Examinations and tests
Examination for an anal fissure begins with a medical examination, and additional methods are used as indicated. Below is a breakdown of what exactly a proctologist does and what results they obtain.
How the examination begins
The proctologist begins the examination for an anal fissure with an inspection of the anal area. The doctor carefully spreads the buttocks to see the fissure itself and assess its location. Such an examination usually does not require instruments and gives an initial picture of the condition of the tissues. Then, if necessary, a digital rectal examination is performed, assessing the tone of the sphincter and the sensitivity of the area. This helps to understand how pronounced the muscle spasm is and whether there are any indurations in the bowel wall. If the examination is difficult due to pain, the doctor postpones instrumental methods until the inflammation subsides. The patient should prepare in advance for the fact that the examination is short, and its results determine further tactics.
What is prescribed and what it shows
What to prepare for the appointment
- Discharge summaries: bring all previous doctors' reports so that the proctologist can see how the condition developed and what has already been ruled out.
- Test results: bring recent laboratory forms, they help assess inflammation and haemoglobin levels without repeat tests.
- Description of complaints: write down when the pain appeared, how long it lasts and whether it is associated with defecation, this will speed up the conversation.
- List of medications taken: list everything you take regularly, including blood thinners, so that the doctor takes this into account during the examination.
- Questions for the doctor: formulate in advance what you want to clarify about your condition, this way the appointment will be more organised and useful.
Which doctor should I see?
This section explains which doctor to consult for an anal fissure, what happens at the first appointment and what areas of care make up the treatment. There are no prescriptions or regimens here: only guidance that helps you choose a specialist and understand the sequence of steps.
Which specialist manages this condition
An anal fissure is managed by a proctologist, and it is to them that patients are referred for pain and discomfort in the anal area. The proctologist examines this area, assesses the condition of the tissues and distinguishes a fissure from other causes of the complaints. At the first appointment, they clarify how long ago the symptoms appeared and how the condition changes after a bowel movement. The doctor also asks about the nature of the stool, diet and previous interventions, because this influences the choice of care. If there is no specialised proctologist nearby, you can start with a surgeon or coloproctologist at the polyclinic at your place of attachment. Such a specialist performs an initial examination and, if necessary, refers you to a proctologist for further management. It is worth making an appointment if pain, blood or difficulty healing persist, without putting the visit off for long.
What treatment consists of
- Selection of therapy by the doctor: the specialist determines which measures are suitable in this particular case and adjusts them as observation proceeds.
- A diet with fibre and fluids: a sufficient amount of dietary fibre and water makes the stool softer and reduces trauma to the tissues during a bowel movement.
- Sitz baths as prescribed: warm procedures help reduce sphincter spasm and ease the unpleasant sensations in the area of the fissure.
- Minimally invasive procedures: they are used when indicated, when conservative measures do not give the desired effect and healing is prolonged.
- Surgery for a chronic fissure: an intervention is considered if the condition does not heal for a long time and recurs, and other approaches have been exhausted.
What depends on the patient themselves
The outcome in anal fissure largely depends on regular follow-up and precise adherence to the doctor's recommendations. If a person follows the diet, drinks enough fluids and does not skip the prescribed procedures, healing proceeds more smoothly and the previous complaints return less often. Refusing some of the recommendations, on the contrary, stretches out the timelines and increases the risk of the condition becoming chronic. It is important to tell the proctologist honestly about changes: worsening pain, the appearance of blood or difficulties with stool, because this changes the further steps. Missing a follow-up appointment deprives the doctor of the opportunity to assess the dynamics in time and adjust the care. Keeping a diary of how you feel helps you notice the connection between diet, stool and sensations. Self-discipline here does not replace treatment, but it noticeably affects how quickly and fully a person returns to their usual rhythm.
What helps prevent an exacerbation?
Preventing an exacerbation of an anal fissure is largely helped by what depends on the person themselves: daily habits, diet and attention to the body's signals. Regular check-ups with a doctor are needed even when there are no unpleasant sensations.
What is changed in habits
An anal fissure heals more calmly when a bowel movement occurs without straining and with a soft stool. Drinking enough throughout the day makes the stool softer and reduces friction during defecation. Foods rich in fibre — vegetables, grains, pulses — add bulk and moisture to the stool, so it passes more easily. If a person suppresses the urge to defecate, the faeces become denser and the mucosa is injured more severely. Prolonged straining in the toilet raises the pressure in the rectum and stretches the edges of the fissure. Timely treatment of constipation and diarrhoea removes the two main causes of repeated injury. It is worth developing the habit of emptying the bowels at the same time each day, without putting off a visit to the toilet for long.
What should be kept under control
- Regularity of stool: emptying without delay and straining indicates that the bowel is working evenly and the mucosa is not being injured again.
- Consistency of stool: a soft and formed mass passes easily, whereas one that is too hard requires effort and damages the edges of the fissure.
- Amount of fluid: drinking enough keeps the stool soft, while a lack of it thickens the contents of the bowel and makes defecation difficult.
- Urges to defecate: they must not be suppressed for long, otherwise the faeces become denser and injure the mucosa at the next visit to the toilet.
- Episodes of constipation and diarrhoea: frequent changes in stool irritate and stretch the edges of the fissure, so such conditions are important to notice and discuss with a doctor.
- Your own sensations: the appearance of pain or blood during defecation should be noted and discussed at an appointment, without waiting for it to worsen.
How often to see a doctor
A regular examination by a proctologist is needed even when you feel well, because the fissure can heal unnoticed and return. The doctor assesses the condition of the mucosa and checks whether there are any indurations and scars that the person themselves will not see or feel. If episodes of pain or blood recur, the visit should not be postponed, but discussed at the earliest appointment. With persistent healing, follow-up examinations are carried out less often, but giving them up completely is not worthwhile. People with chronic constipation or diarrhoea require closer monitoring, because it is these conditions that maintain the injury. Changes in eating and drinking habits should also be discussed with a doctor in order to understand what helps in this particular case. Such monitoring allows an exacerbation to be noticed in time and prevents it from developing into persistent pain.
What is worth remembering
An anal fissure is a condition where it is important not to delay seeing a doctor and not to try to solve the problem on your own. Below are several conclusions that will help you make a balanced decision.
Key conclusions
An anal fissure is often perceived as something temporary that will go away on its own, and this misconception prevents timely help. Delaying a visit to a specialist leads to the acute form becoming chronic, and treatment becoming more complicated. The appearance of pain and traces of blood is a signal to find out the cause, rather than wait for the unpleasant sensations to disappear. A tendency to constipation and straining during bowel movements maintains the damage and prevents the tissues from healing. The doctor determines why the fissure is not healing and selects an approach taking into account concomitant conditions. Regular monitoring and attention to your own well-being help to notice deterioration at an early stage. If an anal fissure recurs, it is worth discussing the causes and further steps with a specialist, rather than postponing the conversation.
