Anal fissures: what they are, symptoms and causes - THDLAB - CO UK

  • What are anal fissures
  • Anal fissures: symptoms
  • Anal fissures: causes

What are anal fissures

Anal fissures are small and deep lesions which form on the mucous membrane of the anal canal. Anal fissures can develop at any age, but they are common between the ages of 20 and 30.

However, children can also suffer from anal fissures. Anal fissures in children are often caused by dehydration, which in adults is only a concurrent cause of the problem. An additional issue which appears more common in children than adults is acute pain, which causes the child to retain faeces that tend to harden, aggravating the problem.

Anal fissures can be acute or chronic:

  • Acute anal fissures
    Acute anal fissures are newly occurred fissures with smooth margins and a pinkish background. Fissures are very painful.
  • Chronic anal fissures
    Chronic anal fissures are anal fissures which have been in place for more than 6 weeks and have never completely healed. These fissures may have raised and whitish margins due to the formation of fibrous tissues.

Anal fissures: symptoms

The most common symptoms of anal fissures are pain, sphincter hypertonia, bleeding and changes in bowel function.

  • pain
    Internal anal fissures are often associated with pain. The pain caused by anal fissures is intense and acute. Pain may occur at the time of defecation and last a few hours after stool evacuation.
  • anal hypertonia
    Pain can cause hypertonia of the anal sphincter, which is a contraction of the sphincter muscle as a reaction to the lesion’s exposure. The contraction of the sphincter reduces the flow of blood to the lesion, slowing down the healing and promoting the chronic aspect of the fissure.
  • bleeding
    In the presence of anal fissures, it is common to observe bright red blood during evacuation.
  • alterations in bowel function
    For some people the pain during defecation is so intense as to cause a fear of evacuating. However, postponing the evacuation favours the onset of constipation which aggravates the problem.

In the presence of these symptoms, it is important to undergo a rectal examination as soon as possible. Only the clinician will be able to identify the most indicated treatment for our case.


Anal fissures: causes

Anal fissures often appear following a micro-trauma in the anal area. The micro-trauma may be due to physical causes, such as solid stools which are too hard and voluminous or to chemical causes, such as diarrhoea and liquid stools.

The pain caused by the anal fissure causes a contraction of the anal sphincter, the muscle that controls continence and the release of faeces (anal hypertonia). Sphincter hypertonia reduces the flow of blood to the lesion and hinders healing. This vicious circle leads to an aggravation of the problem and favours the chronic aspect of the lesion (chronic anal fissure).