Chronic anal fissures are tears in the tissue of the anal canal that last for more than 8 weeks. Unlike acute fissures that often heal on their own, chronic anal fissures require medical treatment.
Chronic anal fissures last more than 8 weeks. Unlike acute anal fissures, which often heal on their own or with home treatments, chronic anal fissures typically need medical treatment.
Medications and surgery are the primary treatment options for these persistent anal fissures.
This article takes a look at the symptoms, causes, and treatment of chronic anal fissures.
People typically notice pain when they have an anal fissure. This pain is often most intense during bowel movements and might last for several hours afterward. Other symptoms of chronic anal fissure can include:
- itching or burning bowel movements
- blood in your stool
- anal spasms
- a lump you can feel on the skin around your anus
Pain, itching, and blood in stools are the most common symptoms of a chronic anal fissure and generally happen at the same time. Symptoms such as anal spasms and a visible lump might develop later on. Not everyone experiences these symptoms.
Stress on the anus or in the anal canal is the primary cause of anal fissures. Tight or inflamed anal muscles can also lead to anal fissures. One of the most common risk factors for anal fissures is chronic constipation.
Additional risk factors include:
- chronic strained and difficult bowel movements
- chronic diarrhea
- obstructed defecation syndrome
- inflammatory bowel disease (IBD)
- Crohn’s disease
- anal cancer
- any trauma to the anus or surrounding area
- surgery in the anus or pelvic area
- infant dyschezia (difficulty pooping)
- certain sexually transmitted infections
But anal fissures are very common. Often, there is no underlying cause or known risk factors that can be identified when someone develops chronic anal fissures.
Acute anal fissures often resolve on their own.
When they don’t, home treatments and lifestyle changes to address constipation are often enough to treat the condition.
But chronic anal fissures normally need medical attention and a treatment plan.
Medical treatment for chronic anal fissures focuses on relaxing the muscles that surround the anal canal so that the fissure can close and heal.
Several treatment options can help achieve this goal. Possible treatments for chronic fissures include:
- Prescription laxatives: Sometimes, doctors might prescribe laxatives to help soft bowel movements and help them pass without stress on your anal canal.
- Nitroglycerin ointment: Nitroglycerin cream is a topical treatment that can expand blood vessels and help your muscles relax. It’s not a good choice for everyone with chronic anal fissures because many people experience headaches as a side effect of nitroglycerin.
- Calcium channel blockers: Calcium channel blockers can relax your blood vessels and the muscles in your anal canal.
- Botox: Botox interjections can also relax muscles. It can be an option if neither nitroglycerin nor calcium channel blockers successfully treat your chronic anal fissure.
- Surgery: Surgery can sometimes be the best option to treat chronic anal fissures. One option is a procedure called an internal sphincterotomy that involves a surgeon making a small cut on the anal muscle to relieve tension. For another option, advancement anal flaps, healthy tissue from another area of the body is used to repair the fissure.
During your treatment, your doctor might also recommend that you take some self-care steps at home. These steps often include:
- adding more fiber to your diet through food choices or supplements
- taking over-the-counter stool softeners
- taking over-the-counter pain relievers
- getting regular physical activity to keep your digestive system moving
- staying hydrated to help your digestive system and promote healing
- taking warm baths multiple times, a day, preferably after bowel movements, to help relax and soothe the area.
What happens if chronic anal fissures are left untreated?
Untreated chronic anal fissures can lead to complications. The pain caused by the fissure can cause spasms and tension. This can make healing difficult and can lead to a wound that is difficult to heal. Over time, this can lead to complications such as:
Chronic anal fissures are tears in the tissue of the anal canal that last for more than 8 weeks. These tears are caused by stress to the anal canal and lead to symptoms such as pain, bleeding, and itching.
Although acute anal fissures often heal on their own in just a few weeks, chronic anal fissures require medical attention.
Sometimes, surgery is required, but noninvasive treatments, such as topical creams, medications, and injections, are also treatment options.