Anal Fissure

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What is an Anal Fissure?

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Anal fissure is a relatively common condition that is often caused by factors such as constipation, anal trauma, and persistent bowel movement.

Anal fissure refers to a small tear or crack in the delicate lining of the anal canal. This condition causes severe pain and bleeding during or after bowel movements, making even simple activities uncomfortable. Although commonly linked to constipation and hard stools, anal fissures can also arise from other factors, such as persistent diarrhoea or underlying inflammatory conditions like Crohn’s disease.

When it is left untreated, anal fissures can disrupt daily life, affecting physical comfort, emotional well-being, and overall quality of life. Individuals may begin to fear bowel movements, leading to avoidance behaviours that further worsen constipation, and create a vicious cycle of pain and distress. Unlike minor skin tears that heal quickly, anal fissures, particularly chronic fissures, often require medical attention to relieve symptoms, promote healing, and prevent complications. 

What are the types of Anal Fissures?

There are several types of anal fissures, which are typically classified based on their duration, and underlying cause. These include:

TYPE OF ANAL FISSUREDESCRIPTION
Acute Anal Fissure
Acute fissures are recent tears that develop suddenly, usually after a particularly hard or large bowel movement.

These fissures often heal within six weeks with simple lifestyle changes, and conservative treatments, such as dietary adjustments, and topical medications.
Chronic Anal Fissure
Chronic fissures are persistent tears that fail to heal within six weeks.

These fissures may have thickened edges or be associated with a sentinel pile, which is a small skin tag at the edge of the fissure.

Chronic fissures often indicate ongoing muscle spasm in the anal sphincter, requiring more complex treatments such as Botulinum toxin (Botox) injections or surgery.
Primary Anal Fissure
A primary fissure occurs in the absence of any underlying medical condition.

This is usually due to mechanical trauma, such as straining during bowel movements or passing hard stools.
Secondary Anal Fissure
A secondary fissure develops as a result of an underlying disease.

These fissures may be linked to conditions such as Crohn’s disease, infections or anal cancer.

Secondary fissures are often atypical in location, sometimes appearing along the sidewalls of the anal canal, rather than the common posterior midline.

What causes Anal Fissures?

Anal fissures develop when the delicate lining of the anal canal tears, usually because of excessive strain or injury. Some of the most common causes include:

What are the symptoms of Anal Fissures?

Some of the common symptoms of anal fissures are:

  • A visible crack near the anal opening
  • Bright red blood on toilet paper or on the surface of stools
  • Persistent itching or irritation around the anus
  • Sharp, burning pain during or after bowel movements

What complications can arise from untreated Anal Fissures?

When anal fissures are improperly managed or left untreated, it can lead to several complications, such as:

COMPLICATIONSDESCRIPTION
Chronic Anal Fissure
Acute fissures that fail to heal within six weeks become chronic.

These fissures develop thickened edges, and may be associated with a sentinel skin tag, a small growth that forms near the tear.
Emotional and Psychological Impact
Persistent pain, and bleeding from chronic fissures can significantly affect quality of life, leading to anxiety, embarrassment, or reluctance to seek medical care.
Infection and Abscess Formation
Fissures can occasionally become infected, especially if there is underlying inflammation or poor hygiene.

This may lead to the development of an anal abscess, a painful collection of pus near the anus.
Persistent Anal Pain and Spasms
The anal sphincter muscle may go into continuous spasm in response to pain, further restricting blood flow to the area, and preventing healing.

This vicious cycle often prolongs symptoms, and complicates treatment.

Who is at risk of developing an Anal Fissure?

Although anal fissures can affect anyone, some groups of people are more vulnerable due to their lifestyle, health status, and specific medical conditions. These risk factors include:

  • Individuals with a history of anal surgery or trauma previous procedures, injuries or infections around the anus can weaken the tissue, raising the risk of recurrent fissures.
  • Individuals with inflammatory bowel disease (IBD) – conditions like Crohn’s disease or ulcerative colitis cause chronic inflammation of the digestive tract, including the anal canal, making fissures more likely to occur.
  • Infants and young children – anal fissures are a common cause of rectal bleeding in infants, usually triggered by constipation.
  • People who engage in receptive anal intercourse – this activity increases the risk of small tears in the anal lining, particularly if lubrication is insufficient.
  • People with chronic constipation or diarrhoea – consistent straining or frequent bowel movements can cause trauma to the anal lining, significantly increasing the risk of fissures.
  • People with reduced blood flow to the anal region – certain medical conditions, including ageing-related vascular changes, may impair blood flow to the anal canal, slowing down healing and making fissures more likely.
  • Pregnant women and new mothers – increased pressure on the pelvic floor during pregnancy, and the strain of childbirth often leads to anal fissures. In fact, this is one of the more common causes of anal fissures in women after delivery.

How are Anal Fissures Diagnosed?

Diagnosing anal fissures at Alpine Surgical Practice involves a comprehensive assessment to confirm the diagnosis, and identify any contributing factors. A typical consultation may involve the following:

During the initial consultation, the following assessments are usually conducted:

  • Medical history review Dr Aaron Poh will ask about your symptoms, including pain patterns, bleeding, bowel habits, and any prior anal or gastrointestinal conditions. We will also review your diet, lifestyle, and history of constipation or diarrhoea.
  • Physical examination our doctor will gently examine the anal area, looking for visible fissures, skin tags or signs of infection. In most cases, the fissure itself can be identified by external inspection.
  • Digital rectal examination – in some cases, a gloved, lubricated finger may be inserted into the anus to assess muscle tone and detect other abnormalities.

Additional diagnostic tests may be recommended if necessary, such as:

  • Colonoscopy if you have additional risk factors such as rectal bleeding, weight loss or a family history of colorectal cancer, a colonoscopy may be advised to rule out other conditions.

How is an Anal Fissure treated at Alpine Surgical Practice?

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A colonoscopy is one of the common diagnostic tools that our doctors will employ to accurately assess an anal fissure.

When it comes to treating anal fissures, the choice of treatment depends on whether the fissure is acute or chronic, as well as the underlying causes. This may include:

Conservative Treatments

  • Adequate hydration – drinking sufficient water promotes smoother bowel movements, and prevents constipation.
  • Dietary adjustments – we recommend increasing your fibre intake through fruits, vegetables, whole grains, and fibre supplements. This softens stools, reducing trauma to the anal lining.
  • Stool softeners – when dietary changes are insufficient, temporary use of stool softeners can further ease passage.
  • Sitz baths – soaking the anal area in warm water for 10 - 15 minutes several times a day can help relieve pain and promote healing.
  • Topical medications – our doctor may prescribe medicated creams, such as topical nitrates or calcium channel blockers, to relax the anal sphincter and improve blood flow to the fissure.

Targeted Medical Treatments

  • Botox injections – this is used to temporarily relax the anal sphincter muscle, reducing spasm, and allowing the fissure to heal.

Surgical Treatments

  • Lateral internal sphincterotomy (LIS) – this procedure involves making a small cut in the internal anal sphincter muscle to reduce spasm, and improve blood flow to the fissure. LIS has a high success rate, and is considered the first-line treatment for chronic fissures.
  • Fissurectomy – occasionally, the fissure itself may be surgically removed, particularly if there is extensive scarring or chronic inflammation.

Summary

One of the best ways to prevent anal fissure is to reduce the amount of time spent on the toilet as it reduces pressure on the anus.

Anal fissures can be a real pain—both figuratively and literally—but thankfully, they are also highly treatable, and early detection helps prevent more serious complications down the line. 

Our compassionate, professional team is here to provide you with discreet, effective treatment tailored to your condition. If you are experiencing anal pain, bleeding or discomfort, contact us today (link to contact us page) for a detailed diagnosis and personalised treatment plan. 

Frequently Asked Questions

How common are anal fissures in Singapore?

Anal fissures are relatively common in Singapore, affecting both adults, and children. Although they are not always discussed openly, they represent one of the most frequent causes of anal pain, and bleeding seen in clinical practice.

Is an anal fissure life-threatening?

Anal fissures themselves are not life-threatening. However, they can cause significant discomfort, and impact daily life. In fact, chronic fissures may lead to infection or other complications.

Can an anal fissure heal on its own?

Acute fissures can often heal on their own with appropriate self-care, such as increasing fibre intake, staying hydrated, and avoiding straining during bowel movements. However, chronic fissures are less likely to heal without medical intervention.

What can I do to facilitate recovery?

You can support healing by:

  • Taking warm sitz baths
  • Avoiding prolonged sitting on the toilet
  • Drinking plenty of water
  • Eating a high-fibre diet
  • Following any prescribed medication or treatment plan
Can anal fissures be prevented?

Yes, you can lower your risk by:

  • Practising good anal hygiene
  • Avoiding excessive straining
  • Maintaining regular, soft bowel movements
  • Managing constipation or diarrhoea promptly
Can anal fissures recur after treatment?

Unfortunately, recurrent fissures can occur, especially if the underlying cause is not well controlled. We will provide individualised advice to help prevent recurrence and maintain long-term anal health.

Can anal fissures lead to cancer?

Anal fissures themselves do not cause cancer. They are benign tears in the anal lining caused by trauma or inflammation. However, in rare cases, fissures that fail to heal, despite appropriate treatment, may warrant further investigation to rule out anal cancer.

This is especially important if:

  • You have additional risk factors, such as a history of anal HPV infection or a weakened immune system
  • The fissure occurs in an unusual location (such as the sidewalls of the anal canal)
  • There are abnormal growths or non-healing ulcers near the fissure site
  • There is persistent bleeding not explained by other causes

How can we help you?

We offer a comprehensive range of consultations for all General Surgical and Abdominal issues.

Let us know how we can help you.
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