Let’s analyze together the fissures, small and deep lesions which can also affect the anal region
The fissures are small but deep lesions of the skin and mucous membranes that can affect various body regions, particularly around the nails, corners of the mouth, behind the ear, around the nipple, and in the anal region. The latter is called “anal fissure“: it is a small, more or less deep ulceration, a few millimeters long, that comes to form at the border between the skin and anal canal and tends to become chronic. It is a common condition in the population affecting both sexes (with a slight male prevalence), regardless of age. Factors which have a major influence on the formation of anal fissures can be numerous, however there are some more predisposing conditions:
- constipation;
- chronic diarrhoea;
- poor personal hygiene;
- trauma;
- sexual habits.
Differences between acute anal fissure and chronic anal fissure
From a clinical point of view, anal fissure can be distinguished into two types: acute and chronic. Acute anal fissure presents as a superficial, reddened and easily bleeding tear often located in the posterior part of the anal canal. If treated immediately, the acute fissure usually resolves in 4 to 6 weeks. Otherwise we speak of chronic anal fissure when the fissure has been present for more than 6 weeks. The chronic anal fissure has hard and thickened margins, the bottom is whitish and deep enough to reach the muscle fibers of the internal anal sphincter. This type of fissure often causes the appearance of a hypertrophic papilla inside the anal canal, while externally the formation of red, swollen and painful swellings.
Symptoms of anal fissures
The symptomatology of anal fissures is characteristic, so as to make the disorder easily identifiable. Although fissures usually appear as small cuts, the pain they involve is considerable because of the presence of abundant nerve endings at this site. We speak of “painful syndrome in three stages of anal fissure“, characterized by:
- Sharp, stinging pain during and after defecation;
- Attenuation for a few minutes;
- Recurrence of pain with varying degrees of intensity.
Anal fissure is usually accompanied also by:
- itching or irritation around the anus, due to irritation of the skin in the area of the fissures;
- bleeding, bright red blood visible on the toilet paper or in the stool as a result of the movement of the external anal sphincter (muscular ring located at the end of the anus) involuntarily contracting;
- burning.
Diagnosis of anal fissures
When anal fissure is suspected, it is essential to consult a proctologist, the medical surgeon who deals with the prevention, diagnosis, and treatment of all disorders and complaints related to the colon-rectal system. The professional will initially perform a careful history taking by analyzing the medical history and listening to the symptoms reported by the patient. Diagnosis is simple and does not require particularly sophisticated instruments: in fact, in most cases the fissure is already visible at an initial divarication of the anus. A delicate digital rectal exploration must then be performed, which, given the possibility of causing pain, is done with particular caution. Then the proctologist will complete the observation with the help of an anoscope. Making an early diagnosis is essential to avoid chronic anal fissure, which occurs rather quickly. In fact, in the presence of chronic fissures, a vicious cycle is triggered that is difficult to solve with medication alone.
Available treatments for anal fissures
The therapy of anal fissures has as its main objective the elimination of the contracture of the anal sphincter through the application of simple measures, such as:
- a diet rich in fruits, vegetables, whole grains and legumes in order to make stools soft;
- maintain accurate intimate hygiene;
- washing with lukewarm water with the goal of relaxing the sphincter and promoting healing;
- the application of topical creams containing local anesthetics and vasoconstrictors in order to reduce pain and inflammation.
In the event that these conservative treatments do not bring benefits and the anal sphincter still remains contracted, the proctologist may prescribe the use of special cryo-thermal anal dilators or balloon dilators, specifically designed and manufactured to obtain a progressive recovery of the elasticity of the anal sphincter, allow healing of lesions and disappearance or improvement of symptoms. Only if the chronic anal fissure does not respond effectively to any of these therapies, the proctologist will consider internal anal sphincterotomy surgery. The surgery is generally performed in an outpatient setting and can provide rapid relief of fissure symptoms and reduce anal canal pressure.
The contents of this page are for informational purposes only and should in no way replace the advice, diagnosis, or treatment prescribed by your physician. Responses to the same treatment may vary from patient to patient. Always consult your doctor regarding any information related to diagnoses and treatments, and meticulously follow their instructions.
