Anal Fissure

What is an Anal Fissure?

An anal fissure is a tear in the mucosa or skin around the anus. It can occur at any age but is particularly common in people who experience constipation, hard stools, or repeated diarrhoea. The tear can cause the muscles surrounding the anus to go into spasm, which may increase pain and reduce blood flow to the area, making healing more difficult. Anal fissures are generally not dangerous, but persistent or recurrent symptoms should be evaluated by a doctor to rule out other causes of anal pain or bleeding.

What are the Types of Anal Fissure?

There are 2 major types of anal fissure. These two types typically include:

Stages of Anal Fissure

The following are the different stages of anal fissure progression:

How Common is Anal Fissure in India?

Anal fissure is common among young and middle-aged adults in India. A study conducted at Tirunelveli Government Medical College found anal fissure in 30.7% of patients presenting with anorectal ailments. Among these patients, 54% were male, and 46% were female, while 98% of fissures occurred in the posterior midline.

The condition is commonly associated with constipation, hard stools and straining during bowel movements. It can cause significant pain and discomfort, especially during or after a bowel movement. Anal fissures can occur at any age but are most common in young and middle-aged adults.

What are the Symptoms of Anal Fissure?

Common early and advanced symptoms of anal fissure include the following:

What Causes Anal Fissure?

Several factors can increase the risk of acquiring anal fissures. Listed below are the main causes of anal fissures:

• Passing Hard Stools: Passing large or hard stools can stretch the anal canal and tear the delicate tissue.

• Low-Fibre Diet: Insufficient dietary fibre can contribute to constipation and harder stools, which may increase the risk of an anal fissure.

• Constipation: Chronic constipation can result in repeated straining and hard bowel movements, increasing the risk of an anal fissure.

• Frequent Diarrhoea: Repeated loose stools can irritate and inflame the anal area, increasing the likelihood of developing a fissure.

• Childbirth: Vaginal delivery can place significant pressure on the tissues around the anus and may increase the risk of developing an anal fissure.

• Anal Trauma: Injury or irritation to the anal canal, including certain medical procedures or local trauma, can sometimes cause a fissure.

• Inflammatory Bowel Disease: Conditions such as Crohn's disease can cause inflammation around the anus and may increase the likelihood of developing fissures.

What are the Complications of Anal Fissure?

Getting diagnosed early and starting antibiotics can greatly lower the risk of anal fissure. Without treatment, this problem can cause serious health issues, such as:

• Skin Tag Formation: Chronic fissures may be associated with a small skin tag or swelling near the edge of the anus.

• Chronic Anal Fissure: An untreated fissure may fail to heal and become chronic, causing persistent or recurrent pain and bleeding.

• Anal Sphincter Spasm: Ongoing irritation can cause persistent tightening of the anal sphincter, which may increase pain and interfere with healing.

• Difficulty Passing Stools: Pain and sphincter spasm can make bowel movements uncomfortable and may cause people to avoid passing stools, worsening constipation.

• Bleeding: Repeated tearing of the anal tissue may lead to recurrent episodes of bright red rectal bleeding.

• Recurrent Fissures: Some people may experience recurrent fissures, particularly when constipation, hard stools, or straining continue.

Related Diseases Comparison

Anal fissure shares symptoms with other similar diseases but differs in its cause, complications, and treatment. Check out the comparison table below:

Anal Fissure vs Haemorrhoids vs Anal Fistula

How is Anal Fissure Diagnosed?

Doctors usually diagnose anal fissure through a physical examination and medical history review. Various methods to diagnose this condition are as follows:

How is Anal Fissure Managed?

Anal fissure can be managed in the following ways:

• Nitroglycerin: Applied to the skin around the anus, nitroglycerin can improve blood flow to the fissure and relax the anal sphincter, helping promote healing. It may cause headaches, which can sometimes be severe.

• Topical Anaesthetic Creams: Medicines such as lidocaine can be applied to the affected area to provide temporary relief from pain and discomfort.

• Botulinum Toxin (Botox) Injections: Botox can be injected into the anal sphincter to relax the muscle and reduce painful spasms, which may help the fissure heal.

• Nifedipine or Diltiazem: These blood pressure medicines can help relax the anal sphincter when applied topically. They may also be taken orally, although oral forms can cause more side effects. They may be considered when nitroglycerin does not work or causes significant side effects.

• Lateral Internal Sphincterotomy (LIS): Surgery may be considered for chronic anal fissures that do not respond to other treatments or when symptoms are severe. In this procedure, the surgeon cuts a small portion of the internal anal sphincter to reduce muscle spasm, relieve pain and promote healing.

• Surgery: If a chronic fissure does not respond to other treatments, a surgical procedure called lateral internal sphincterotomy may be considered to relax part of the internal anal sphincter and allow the fissure to heal.

Medicines Used to Treat Anal Fissure

There are several medicines that help manage anal fissure by easing symptoms and lowering the number of outbreaks. These medicines include the following:

• Bulk Laxatives: These may help people with constipation or very hard stools that put additional strain on an anal fissure. Medicines containing psyllium can draw water into the bowel and help soften stools.

• Calcium Channel Blockers: Medicines such as diltiazem and nifedipine can help relax the blood vessels and anal muscles. Consider them when nitroglycerin is not suitable or does not provide enough relief.

• Nitroglycerin Ointment: Nitroglycerin widens blood vessels and improves blood flow to the affected area. It can also relax the anal sphincter and support healing, although headaches may occur as a side effect.

• Botox Injections: Doctors can inject botulinum toxin into the anal sphincter to relax the muscle and reduce spasms. Its effects may last for around three months, giving the fissure time to heal.

Disclaimer: Always consider your healthcare provider's recommendations when taking such medicines.

Can Anal Fissure Be Cured?

Yes, anal fissure can usually be cured, especially when it is treated early and the underlying cause is addressed. Most acute fissures can heal with simple measures such as eating enough fibre, drinking plenty of water, keeping stools soft, avoiding straining and maintaining good bowel habits. Persistent or chronic fissures may require medicines that relax the anal sphincter or procedures such as botox injections.

In cases that do not respond to other treatments, surgery such as lateral internal sphincterotomy may be considered to promote healing and relieve ongoing pain.

Anal Fissure During Pregnancy

Anal fissures can occur during pregnancy, particularly when hormonal changes contribute to constipation and harder stools. Pressure from the growing uterus and changes in bowel habits may also make it harder to pass stools. Most pregnancy-related fissures can be managed with adequate fluids, a fibre-rich diet, physical activity, and medicines recommended by a healthcare professional. Pregnant women should consult their doctor before taking laxatives, pain medicines, or topical treatments.

Tips to manage anal fissure during pregnancy are as follows:

• Include plenty of fibre-rich foods in your daily diet.

• Drink adequate water throughout the day.

• Avoid straining during bowel movements.

• Do not ignore the urge to pass stool.

• Take regular, pregnancy-safe physical activity as advised by your doctor.

• Use warm sitz baths to help relieve discomfort.

Can Anal Fissure Be Prevented?

The various precautionary steps to prevent anal fissure are as follows:

• Maintain Good Anal Hygiene: After a bowel movement, gently clean the anal area. Avoid rubbing too hard or using harsh soaps, as these can cause irritation.

• Respond to the Urge to Pass Stool: Avoid regularly delaying bowel movements, as this can contribute to harder stools and constipation.

• Stay Physically Active: Staying active can help keep your bowel movements regular and lower your risk of constipation.

• Maintain a High-Fibre Diet: Include fibre-rich foods such as fruits, vegetables, whole grains, legumes, and other fibre sources to help prevent hard stools.

• Drink Enough Water: Drink enough water to help keep stools softer and may reduce constipation.

• Avoid Straining: Try not to strain too much or spend a long time on the toilet when having a bowel movement.

• Manage Diarrhoea: Ongoing diarrhoea can irritate the anal area. Make sure to get it checked and treated if it continues.

Anal Fissure Treatment Cost in India

The cost of anal fissure treatment depends on the size, location, number of fissures, hospital charges, and the type of procedure performed. The following table includes the estimated treatment costs in India:

Disclaimer: The prices listed here are estimates that may change depending on the hospital's location, amenities, and other factors.

Does Health Insurance Cover Anal Fissure?

Yes, anal fissure treatment, including surgery, may be covered by health insurance when it is considered medically necessary and is covered under the policy terms. Depending on the policy, coverage may include hospitalisation, eligible day-care procedures, and certain pre- and post-hospitalisation expenses.

However, some health insurance policies may also have a minimum waiting period, particularly for pre-existing conditions. The waiting period for pre-existing diseases under most health plans ranges from 1 to 4 years, depending on the insurer and policy terms. The applicable waiting period and coverage can vary by insurer and mediclaim policy, so it is important to check the policy terms before buying a plan.

How Much Health Insurance Coverage is Needed for Anal Fissure Treatment?

The cost of treating an anal fissure depends on its severity and whether conservative treatment or a surgical procedure is required. Mild fissures can often be managed with medicines and lifestyle changes, while chronic cases may require procedures or surgery and associated hospitalisation costs. A mediclaim policy with a minimum sum insured of ₹5–₹10 lakh can provide reasonable financial protection for treatment and other unexpected medical expenses. Individuals with broader healthcare needs may consider a higher sum insured.

Living with Anal Fissure in India: Daily Challenges & Care

Dealing with an anal fissure can be uncomfortable, especially if you feel pain during bowel movements. With proper care and treatment, most people are able to manage their symptoms and help the healing process.