Anal Fissure

What is an anal fissure?

An anal fissure is a very common small tear or crack in the lining of the anus, which can cause rectal bleeding, discomfort, and anal pain during bowel movements. Anal trauma, from straining to passing hard stools, can result in a fissure. Additionally, an anal fissure can occur either suddenly or gradually, just as it can heal either quickly or slowly.

What causes an anal fissure?

The main cause of an anal fissure is anal trauma. The trauma can result from forcibly stretching or straining the anal lining to the point where it tears or cracks. However, some pre-existing conditions can lead to anal fissures, particularly the anatomy of your anus.

While the skin towards the end of the anus is similar to the skin outside of your body, the skin in the upper portion of the anus is lined with soft mucosa, which is the same soft tissue as the large intestine. As such, the lining is more sensitive to tears and cracks due to its thinner and more delicate nature, especially among babies.

Additionally, there are two circular muscles that help the anus control the bowel movements, called anal sphincters. If these muscles are too tight, it adds tension to the anal lining, making it more susceptible to tears, to a point where it may reduce blood flow to the tissues.

Some of the other common causes of anal fissure include:

• Childbirth: women may develop anal fissures during childbirth due to the stretching and tearing of the anal tissue.
• Constipation: passing hard or large stools can stretch the anus, causing tears.
• Inflammatory bowel disease (IBD): IBD especially Crohn’s Disease predisposes patients to anal fissure.

What are the symptoms of an anal fissure?

Some of the common anal fissure symptoms include:

• A burning sensation or sharp pain that lasts for hours after bowel movements
• A crack or tear in the skin around the anus
• Fresh (bright red) blood in the toilet or on toilet paper
• Itching or irritation around the anus
• Pain or discomfort during bowel movements

Are you experiencing any of the above symptoms? Make an appointment with Lee Surgery & Endoscopy.

Who is at risk of anal fissures in Singapore?

Anal fissures can occur in individuals of any age in Singapore, but certain factors can increase the risk of developing them. Here are some factors that may contribute to an increased risk of anal fissures:

• Constipation: straining during bowel movements can lead to the development of anal fissures. Hard, dry stools can stretch and tear the delicate lining of the anus, causing a fissure.
• Anal trauma: trauma to the anal area, such as injury during childbirth, anal intercourse, or insertion of foreign objects into the anus, can cause tears or fissures in the anal lining.
• Inflammatory bowel disease (IBD): IBD, which is characterised by chronic inflammation of the digestive tract, increases the risk of anal fissures.

How is anal fissure diagnosed in Singapore? 

Anal fissures are usually diagnosed in Singapore using a combination of the following:

• Medical history and physical examination: your specialist will inquire about your medical history, including symptoms, bowel habits, dietary factors, and any previous episodes of anal discomfort or bleeding. They may ask about factors such as constipation, diarrhoea, straining during bowel movements, or recent childbirth.
• Digital rectal exam: a digital rectal exam may be performed to assess the tone and integrity of the anal sphincter muscles and to check for any abnormalities.
• Anoscopy or proctoscopy: an anoscopy or proctoscopy may be performed to obtain a closer view of the anal canal and rectal mucosa. These procedures involve inserting a thin, flexible tube with a light and camera into the anus to visualise the lower rectum and anal canal. 

What are the treatment options for anal fissure in Singapore?

The treatment of anal fissure in Singapore typically aims to relieve symptoms, promote healing of the fissure, and prevent recurrence. Treatment options for anal fissures may include:

• Topical medications: topical medications, such as local anesthetic cream, ointments, and calcium channel blockers are applied to the anal fissure to help with recovery.
• Oral medications: laxatives and pain medication can help reduce pain and straining during bowel movements.
• Botulinum toxin injections: these injections can help relax the anal sphincters and promote healing of the anal fissure.
• Lateral internal sphincterotomy: a lateral internal sphincterotomy involves cutting a small portion of the internal anal sphincter muscle to reduce sphincter pressure and improve blood flow to the fissure, allowing it to heal. 
• Lifestyle changes: increasing fibre intake and improving hydration can help prevent straining and pressure during bowel movements.

Frequently asked questions

Do anal fissures go away?

Anal fissures can heal on their own in some cases, particularly if they are acute or mild. With proper self-care and conservative treatments, many anal fissures improve within a few weeks to months. However, some fissures may persist or become chronic, requiring medical intervention to promote healing and alleviate symptoms.

What are the possible complications of an anal fissure?

Although anal fissures are common and are typically not life-threatening, they can be extremely painful. In fact, most anal fissures heal within a few days or weeks at most. But some anal fissures, such as chronic anal fissures, are more complicated and may require more time to heal and further treatment.

Can anal fissures recur?

Yes, anal fissures can recur, especially if underlying factors that contribute to their development are not addressed or if previous treatments were not successful in promoting healing. Recurrence of anal fissures is relatively common and can occur even after successful treatment and resolution of symptoms.