Anal Fissure: Rectal Pain & Bleeding

An anal fissure is a rectal tear: a tear in the anal canal that causes rectal pain and rectal bleeding. Anal fissure can occur at any age, but are most common in infants: Up to eighty percent of babies develop an anal fissure before their first birthday.

Causes of Anal Fissure

A rectal tear is usually caused by constipation. Bowel movements involving hard, large stools damage the anal canal, causing a longitudinal rectal tear. An anal fissure runs along the length of the anal canal.
Severe diarrhea or anal canal inflammation can also cause anal fissure: Both conditions irritate and dry the anal canal, increasing the risk of a rectal tear.
In elderly individuals, reduced blood flow to the rectal area is one of the causes of anal fissure. Physical trauma and childbirth can also cause rectal tears.
Abuse of laxatives is associated with a high risk of anal fissure. While anal intercourse is one of the least common causes of anal fissure, it can also result in a rectal tear.

Anal Fissure and Rectal Tear Symptoms

Rectal pain and rectal bleeding are the most common symptoms of an anal fissure. Rectal pain is especially intense during bowel movements, when the anal fissure is stretched.
Rectal bleeding due to an anal fissure may be detected as blood in the toilet or on toilet paper following bowel movements. Rectal bleeding caused by a rectal tear will produce bright red blood. Itching may also be present.
The combination of rectal bleeding, rectal pain and itching caused by an anal fissure leads many people to believe they are suffering from hemorrhoids. In fact, hemorrhoids cause rectal pain only when ulcerated or thromosed.

Rectal Bleeding and Anal Fissure Diagnoses

Rectal bleeding can be a sign of many conditions, so careful examination is essential during an anal fissure diagnosis. Physical confirmation of the rectal tear is required to determine the cause of rectal bleeding and pain.
Physical examination of the anal region is usually sufficient to diagnose an anal fissure. In some cases, a small skin flap called a sentinel pile may protrude through the anus.

Rectal Pain Interferes with Anal Fissure Diagnosis

Rectal pain caused by an anal fissure can cause muscle spasms, making visual confirmation of the rectal tear difficult. Additionally, physical examination of the anal fissure can cause excruciating rectal pain. If this is the case, sedation may be required to complete the physical exam.

Unusual Rectal Tears

Most anal fissures are longitudinal: a single tear that runs down the anal canal. A lateral tearan anal fissure that stretches across the anal canalor multiple rectal tears may indicate an underlying health condition. Possible causes of lateral anal fissure include:
  • cancer
  • Crohn's disease
  • immunosuppression
  • infections
  • inflammatory disorders
  • syphilis
  • tuberculosis.

Treatment of Anal Fissures and Rectal Pain

Anal fissures often resolve by themselves. Those that don't heal require treatment to assist healing and alleviate rectal pain. Initial treatment may include stool softeners to ease bowel movements and relieve rectal pain. If the anal fissure is infected or appears ulcerated, antibiotics may be prescribed to promote healing.
Self-care for an anal fissure can speed the healing process and alleviate rectal pain. Self-care techniques include:
  • keeping the anus and buttocks area clean
  • patting the anus dry with a soft towel after bathing
  • sitz baths in warm water several times a day.
Sitz bathsbathing the anal regionshould always use warm water, never hot. After bathing, some doctors recommend talcum powder to keep the anal region dry.

Medications for Anal Fissure

Muscle spasms caused by rectal pain prevent the healing of anal fissures. A variety of medications can relax the anal sphincter and prevent muscle spasms, including:
  • botulinum toxin (BOTOX®)
  • l-arginine gel
  • nifedipine
  • salbutamol
  • topical bethanechol
  • topical isozorbide dinitrate
  • topical nitroglycerin.
BOTOX is a relatively new anal fissure treatment. When injected into the anal sphincter, botulinum toxin binds to the sphincter's presynaptic nerves, temporarily preventing acetylcholine action. Nerve action in the anal region is impaired for up to three months, reducing rectal pain and muscle spasms. BOTOX is effective in up to ninety percent of anal fissure cases, and has only a ten percent likelihood of rectal tear relapse.

Rectal Tear Surgery

Anal fissure surgery is usually reserved for cases where other rectal tear treatments prove ineffective, or if rectal pain is particularly intense. The standard treatment for anal fissure in the United States is a lateral sphincterotomy.
During anal fissure surgery the rectal tear and any surrounding scar tissue is removed from the anal canal. To prevent post-surgical muscle spasms, a small incision is made in the anal muscle.
Complications from anal fissure surgery include slight fecal incontinence in five percent of cases. Some people experience less control over flatulence than they had before the surgery.

Comments

Post a Comment

Popular posts from this blog

Pernicious Anemia: Vitamin B12 Deficiency

Image
Anemia  is a blood disorder in which the number of red blood cells or the amount of hemoglobin is lower than normal. With fewer red blood cells or hemoglobin, insufficient oxygen is delivered to the body 's cells. Pernicious anemia  is a type of anemia caused by a deficiency in vitamin B12. In pernicious anemia, the lack of vitamin B12 is due to the body 's inability to produce enough  intrinsic factor , a protein necessary for the absorption of vitamin B12. Pernicious anemia is a type of  megaloblastic anemia . Megaloblastic anemia is defined as, "a blood disorder characterized by anemia, with red blood cells that are larger than normal, usually resulting from a deficiency of folic acid or of vitamin B12 .  " (U.S. National Library of Medicine) Pernicious anemia by any other name . . . Pernicious anemia is known by a number of other names, including: macrocytic achylic anemia congenital pernicious anemia juvenile pernicious anemia vitamin B12 deficienc
Keep reading

Stress Relaxation Techniques

The ultimate goal in stress coping and management is to reduce the negative effects of stress. Different relaxation techniques have proved successful and can be used based on individual preference. Brief descriptions of various techniques follow. If you are interested in pursuing the use of these techniques further, more information is available in books or on tapes. These books and tapes can be purchased at bookstores or may be accessible at your library. Deep Breating as a Relaxation Technique Deep breathing is the most basic relaxation technique and is often the foundation for other methods. The primary benefit is that deep breathing can be done anywhere and anytime. It is beneficial to practice deep breathing several times a day. The methodology consists of completely filling the lungs when breathing so that the abdomen expands out ward. You begin by taking a deep breath and then exhaling slowly through the mouth. A hand can be placed on the stomach to ensure that it is fully e
Keep reading

Nutrition & Cystic Fibrosis

Image
Cystic fibrosis is a genetic disorder that affects the body's exocrine glands, including the various mucus and sweat glands found throughout the body. Since cystic fibrosis is an inherited disease, most people with the disease are usually diagnosed by their first birthday. The most common problems due to cystic fibrosis are related to the lungs and the digestive system. In the lungs, the mucus produced by the various exocrine glands is abnormally thick, creating obstructions in the breathing passageways and, eventually, damage to the lungs. Furthermore, the thick mucus creates an ideal breeding ground for various bacteria and other organisms, which results in frequent lung infections, damage to the lungs and, ultimately, respiratory failure. Cystic fibrosis also affects the pancreas. The pancreas is responsible for producing various enzymes to aid in digestion, but in cystic fibrosis the pancreas is unable to excrete sufficient amounts of pancreatic enzymes to help digest foo
Keep reading