Anal Tears

What are anal tears?

Anal tears, also called anal fissures, are small rips in the skin of the anus. They usually occur as a result of passage of hard dry stools. Diarrhoea may however cause it in some people as well.

These tears usually heal on their own over time but some may persist for up to six weeks. In this case, they are referred to as ‘chronic’.


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What are the symptoms?

The main symptoms are pain and blood in stool. The pain may be sharp and intense, and may last for an hour or more after passing stool. The blood is usually bright red and of small volume, and this small volume helps differentiate them from haemorrhoids (clusters of swollen blood vessels) also called ‘piles’.


What treatments work?

Consuming high-fibre diets may be helpful. It makes stools softer and easier to pass through the anus. These foods include vegetables, fruits and wholegrains. Drinking enough water helps prevent constipation.

Having frequent warm baths (sitz baths) may help ease the pain caused by the tear and relax the anal muscle.

The doctor should determine whether laxatives should be used for constipation.


Medical treatments

If the above measures fail to relieve your symptoms, your doctor might prescribe glyceryl trinitrate (GTN) which comes as an ointment that you rub on your anus. It helps to increase blood supply to the anus and helps healing to take place. However, one of GTN’s major side effect is headache.

Drugs ordinarily used to manage hypertension called calcium channel blockers (CCBs) may sometimes be used in the form of ointments for severe symptoms.

When these still fail, your doctor may suggest injections of botulinum toxin (Botox) into the muscle of the anus. Botox works by weakening the anal muscles so that they are not able to tighten up and cause pain. Side effects of this include loss of bowel control for about a week post-treatment.


Surgical treatments

When the medical and other treatments fail, surgery becomes an option. The surgeries are quite simple and can be done while you are awake by using a local anaesthetic (numbing) agent.

The most common is called an internal anal sphincterotomy. The surgeon makes a small cut in the anal muscle to ease off the grip a bit. It is quite effective in promoting healing of tears, but it can also cause temporary loss of bowel control.

The other type of operation is called an anal advancement flap. The surgeon stitches normal skin over the tear. It is less effective than the former but there is no associated risk of incontinence.