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Sign and Symptoms of Anal Fissure
Anal fissures are cracks or tears in the anus and anal canal. They may be acute or chronic. Anal fissures are caused primarily by trauma, but several non-traumatic diseases are associated with anal fissures and should be suspected if fissures occur in unusual locations. The primary symptom of anal fissures is pain during and following bowel movements. Bleeding, itching, and a malodorous discharge also may occur. Anal fissures are diagnosed and evaluated by visual inspection of the anus and anal canal. Endoscopy and, less commonly, gastrointestinal x-rays may be necessary.They affect men and women equally and both the young and the old. Fissures usually cause pain during bowel movements that often is severe. Anal fissure is the most common cause of rectal bleeding in infancy.
Anal fissures occur in the specialized tissue that lines the anus and anal canal, called anoderm. At a line just inside the anus; the skin (dermis) of the inner buttocks changes to anoderm. Unlike skin, anoderm has no hairs, sweat glands, or sebaceous (oil) glands and contains a larger number of somatic sensory nerves that sense light touch and pain. (The abundance of nerves explains why anal fissures are so painful.)
Most anal fissures are caused by stretching of the anal mucosa beyond its capability.
Anal fissures are caused by trauma to the anus and anal canal. The cause of the trauma usually is a bowel movement, and many patients can remember the exact bowel movement during which their pain began.
The fissure may be caused by a hard stool or repeated episodes of diarrhea.
Occasionally, the insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland) can result in sufficient trauma to produce a fissure.
During childbirth, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm.
In older adults, anal fissures may be caused by decreased blood flow to the area.
Patients with anal fissures almost always experience anal pain that worsens with bowel movements.
The pain following a bowel movement may be brief or long lasting; the pain usually subsides between bowel movements.
The pain can be so severe that patients are unwilling to have a bowel movement, resulting in constipation and even fecal impaction. Constipation can result in the passage of a larger, harder stool that causes further trauma and makes the fissure worse.
The pain can also affect urination by causing discomfort during urinating, frequent urination, or the inability to urinate.
If acute they may cause severe periodic pain after defecation but with chronic fissures pain intensity is often less.
- Bleeding in small amounts, itching, and a malodorous discharge may occur due to the discharge of pus from the fissure. This blood is separate from the stool. Blood mixed with the stool indicates some other conditions (like colon cancer and inflammatory bowel disease).
- Anal fissures commonly bleed in infants.
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