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You are starting a bowel movement and you suddenly feel a sharp pain in your anal area. When you look in the toilet you see bright red blood, or you see bright red blood on your toilet paper. Don’t panic, these are not the symptoms of anal cancer. You probably have an anal fissure.
What Are Anal Fissures?
Anal fissures are tears in the inner lining of your anal canal. Your anal canal is the short tube at the end of your rectum. The opening of the anal canal for a bowel movement is controlled by a circular muscle called the anal sphincter. A tear in the inner lining (mucosa) of your anal canal is usually caused by passing a hard and large stool. People with tighter anal sphincters and people with frequent constipation are at higher risk for an anal fissure.
Chronic Anal Fissure
Pain from an anal fissure can be severe and it can continue after a bowel movement. Your anal sphincter may go into a spasm and cause pain for minutes or even hours. Not Surprisingly, this can make someone want to avoid having a bowel movement. Avoiding bowel movements leads to harder and larger stools. Tears take several weeks to heal and a hard and large bowel movement can reopen a healing sphincter. This type of cycle can delay healing for six to eight weeks. When this happens, it is called a chronic anal fissure.
Anal Fissures vs Hemorrhoids: What’s the Difference?
Hemorrhoids will typically come with the same symptoms of anal fissures, but these are different injuries. While fissures are tears around your rectum, hemorrhoids are irritations in the skin. The skin will bubble up and fill with blood. Many people suffering from hemorrhoids also have fissures at the same time.
How to Treat Anal Fissures
Although anal fissures are not dangerous, you should always see your doctor if you have any blood in your stool or rectal bleeding. Your doctor can usually diagnose an anal fissure from your history and a rectal examination. The other common cause of rectal bleeding is hemorrhoids. Hemorrhoids also cause bright red bleeding during a bowel movement, but the bleeding is usually not painful. Bleeding from a rectal or anal cancer can cause bright red blood, but not the severe pain of a fissure.
Home Treatment for Anal Fissures
In most cases, treatment of an anal fissure starts with home treatment. Because constipation and large hard stools are the usual cause of a fissure, softening your stool and preventing constipation are the first steps in-home treatment. Home treatment instructions may include:
- Add fiber to your diet by eating more fruit, vegetables and whole grains. Try to get about 30 grams of fiber each day.
- Increase the amount of water you drink every day.
- Use a fiber supplement like Metamucil as directed.
- Use an over-the-counter stool softener as directed.
- Sit in a warm tub for 10 to 20 minutes a few times during the day, especially after a bowel movement. This may relieve pain and increase healing.
If these home care treatments are not helping, your doctor may prescribe medications to take at home. These include medications to increase blood flow to your anal area and topical creams or ointments to relieve pain.
Surgical Treatment for Anal Fissures
If you have a chronic anal fissure, you may need to see a rectal surgeon. The first option may be to inject your anal sphincter with a medication called Botox to relax the muscle and prevent spasms. This treatment is 50 to 80 percent successful. If all else fails, a surgical procedure may be needed to cut the anal sphincter muscle, called a sphincterotomy. Although this procedure is rarely needed, it is successful over 90 percent of the time.
How to Prevent Anal Fissures
Preventing constipation and hard stools is the best way to prevent an anal fissure. Constipation prevention includes getting plenty of fluid, exercise, and fiber in your diet. Let your doctor know any time you have rectal bleeding. Ask your doctor for help if you have frequent constipation.