An anal fissure is a cut or crack in the lining of the anus that extends to the sphincter muscle. A fissure at the back of the anus, the most common injury, occurs equally in males and females. A fissure in the front of the anus, the rarer type, is 10 times more common in females. The chance for cure is very good, especially with surgery and good anal hygiene.
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What Causes it?
A fissure at the back of the anus results from passage of large, hard stools that stretch the rectal lining beyond its limits. A fissure at the front usually results from strain on the perineum during childbirth and, rarely, from scar tissue that narrows the passage. Occasionally, the fissure is caused by inflammation, anal tuberculosis, or cancer.
What are its Symptoms?
An acute anal fissure starts with tearing, cutting, or burning pain during or immediately after a bowel movement. A few drops of blood may streak toilet paper or underclothes. Swelling at the lower end of the fissure, called a sentinel pile, can cause painful spasms. Repeated fissures leave scar tissue that hampers normal bowel movement.
How is it Diagnosed?
The doctor can use a scope to see the tear. Probing the area will cause pain and bleeding. The doctor may also pull back the skin to expose the swelling at the end of the fissure.
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How is it Treated?
If the tear is superficial and no hemorrhoids have developed, the doctor may numb the area with a local anesthetic and stretch the sphincter muscle with his or her fingers. If the fissure has caused complications, it may require surgery to remove some tissue and loosen the muscle.