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Causes of Anal Fissure and Symptoms
Anal Fissure – small tears in the tissue around the ANUS. Anal fissures can be internal or external. They typically are painful and may bleed with bowel movements, resulting in small amounts of bright red BLOOD on the toilet tissue or in the toilet bowl. The most common cause of anal fissure is CONSTIPATION, in which the bowel movement is hard and often forced. PAIN can be intense with bowel movements.
The doctor can diagnose anal fissure on the basis of the symptoms and by examining the anal area, though may perform an anoscopy to examine the inner anus. Most anal fissures heal with conservative treatment that includes frequent sitz baths, topical application of hydrocortisone preparations to reduce INFLAMMATION, high-fiber diet and stool softeners to pull more moisture into the stools, and daily physical exercise such as walking to improve intestinal motility (movement of food through the gastrointestinal tract) and encourage regular bowel movements.
Anal Fissure Treatment
The next level of treatment for anal fissure that persists is topical nitroglycerin or topical nifedipine (a calcium channel blocker), both of which increase blood flow to the anal sphincter and cause it to relax. Doctors prescribe these medications in oral form to relax the CORONARY ARTERIES as a treatment for CORONARY ARTERY DISEASE (CAD); the pharmacological action on the blood vessels in the anal area is similar. Nitroglycerin ointment, like other forms of nitroglycerin, can cause HEADACHE and dizziness.
Another treatment option is BOTULINUM THERAPY, in which the doctor injects the anal sphincter near the fissure with botulinum toxin to temporarily paralyze the MUSCLE fibers, which relaxes the sphincter. The effect of the botulinum toxin lasts about three months. Extensive anal tears and fissures that do not heal with other treatments may require surgical repair. INFECTION may develop with persistent or extensive anal fissure, and requires appropriate antibiotic therapy.