Anal Fissures

What are Anal Fissures?

Anal fissures are a cut or tear in the skin of the anus. They can affect anyone of all ages in Singapore but are more common in young infants. An anal fissure may be small and superficial; or it may be deep enough to expose the anal sphincter, which is the layer of muscle surrounding the anus.

Anal fissures can either be acute (if it lasts less than 6 weeks) or chronic (if it lasts more than 6 weeks and is a recurring condition). It is a common medical condition, and they often occur together with piles/haemorrhoids.
Studies have shown that 20% of patients with haemorrhoids have accompanying anal fissures.

What causes Anal Fissures?

Anal fissures usually occur due to over-stretching of the anal canal. This can be caused by:

Constipation: passing large or hard stools can tear the lining of the anal canal resulting in an anal fissure.
Prolonged diarrhoea: irritation to the anal canal from frequent and prolonged diarrhoea can tear the skin of the anus.
Anal intercourse: stretching the anus can cause tears on the skin of the anus.
Foreign objects: inserting foreign objects into the anus can cause it to over-stretch and result in anal fissures.
Overly tight anal sphincter: if the anal sphincter is too tight, it will tear when it stretches even for normal bowel movements.

Medical conditions: inflammatory bowel disease (IBD), anal cancer, leukemia, tuberculosis, sexually transmitted diseases (such as syphilis, gonorrhea, chlamydia, HIV)
Decreased blow flow to the anorectal area: seen most often in individuals with chronic anal fissures.
Childbirth: anal fissures and piles/haemorrhoids occur in about 40% of all pregnant or post-partum women.

What are the symptoms of Anal Fissures?

Pain: this will occur during a bowel movement and can last for a few hours after.
Bloody stools: blood on the surface of stools usually indicate an anal fissure.
Blood on tissue paper: this usually indicates an anal fissure.
Torn anal skin: this is a visible tear or cut on the anal skin.
Burning or itching: occurs in the anal area.
Discomfort when urinating: this is also accompanied by frequent urination or inability to urinate.
Smelly discharge: smelly discharge around the anal fissure.

Are Anal Fissures painful?

Yes, they can be incredibly painful during a bowel movement or even a few hours after the bowel movement.

Who is at risk of anal fissures in Singapore?

Like most conditions, there are various factors that increase a person’s risk of an anal fissure. These factors are:

Constipation: straining and using a large amount of force to have a bowel movement that is often accompanied by hard and large stools, can increase the risk of an anal fissure.

Childbirth: anal fissures and piles/haemorrhoids occur in about 40% of all pregnant or post-partum women.

Crohn’s disease: may cause inflammation of the gastrointestinal tract which makes anal fissures more likely.
Anal intercourse: over-stretching the anal skin can cause it to tear.
Age: although anal fissures can occur to anyone at any age, it is more common in infants and middle-aged adults.

How are Anal Fissures diagnosed?

Most of the time, an anal fissure can be diagnosed with just a visual examination as there will be an obvious tear in the anal skin. However, if your gastroenterologist suspects other underlying conditions to be the cause of your anal fissure, the following tests may be conducted:

Colonoscopy: a thin and flexible tube with a camera and light attached at one end, is inserted into the anus and led up through the rectum and large intestine for a proper examination.
Sigmoidoscopy: used to examine the insides of the rectum and anus.
Anoscopy: small tube used to examine the lining of your anus.

What are the treatment options for Anal Fissures in Singapore?

Minor acute anal fissures can often heal by themselves, while chronic anal fissures may require some help with the following treatment options:

Fibre: studies have shown that increasing fibre intake and warm sitz baths resulted in better healing and relieved symptoms.
Sitz baths: help improve hygiene and alleviate pain.
Topical nitrates: creams that can be applied on the anal fissure to help improve blood flow and encourage healing.
Topical anaesthetic creams: helps relieve pain.
Botox injections: helps relax the anal sphincters and prevent muscle spasms.
Lateral internal sphinterotomy: cuts a small section of the anal sphincter to reduce pain and muscle spasm and improve healing.
Endorectal advancement flaps: used only for chronic anal fissures.
Fissurectomy: used for the treatment of chronic anal fissures.

Frequently asked questions

Can anal fissures heal on their own?

If the anal fissure is small enough, it can heal by itself. However, if the anal fissure is large, external treatment may be required to help it heal.

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