Anal Fissure

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Disclaimer

The information provided below is for educational purposes only and should not be considered as medical advice or recommendation. The content is based on general knowledge and available research, but it does not replace the diagnosis, treatment, or advice of a qualified healthcare professional.

Important Note:

If you are experiencing symptoms or concerns related to anal fissures or any other health condition, please seek immediate attention from a licensed physician or healthcare provider. They will be able to assess your individual situation and provide personalized guidance on the best course of treatment for your specific needs.

The information provided in this article is not intended to:

  • Diagnose or treat any medical condition

  • Substitute for professional medical advice or consultation

  • Encourage self-treatment or self-diagnosis

  • Be used as a substitute for regular medical care

By reading and using the information provided, you acknowledge that you understand and agree with the following:

  1. This content is not intended to create a doctor-patient relationship.

  2. Any reliance on the information presented is at your own risk.

  3. You should consult with a qualified healthcare professional before making any decisions or taking any actions related to your health.

Remember:

Only a licensed healthcare provider can provide you with personalized medical advice and treatment based on your unique needs and circumstances. If you have any concerns or questions, please do not hesitate to contact a qualified healthcare professional for guidance.

Introduction to Anal Fissures

As uncomfortable as it may be to discuss, anal fissures are a common condition that can cause discomfort and pain for many people. In this section, we will break down what an anal fissure is, what causes it, the symptoms you might experience, treatment options, and the prognosis.

What is an Anal Fissure?

An anal fissure is a tear or cut in the lining of the anus, which can cause pain, bleeding, and discomfort during bowel movements. It is like having a small wound on your bottom that does not heal easily.

Causes

Anal fissures are usually caused by one of these factors:

  • Constipation: Straining during bowel movements due to hard or irregular stool can cause the lining of the anus to tear.

  • Diarrhea: Loose, watery stools can put pressure on the anus, causing a tear or cut.

  • Childbirth: Vaginal delivery can cause stretching and tearing of the anal canal.

  • Trauma: Accidents, such as falling or being in a car accident, can lead to an anal fissure.

  • Weakened muscles: Weakened muscles in the pelvic floor due to aging, childbirth, or surgery can contribute to the development of an anal fissure.

Symptoms

If you have an anal fissure, you might experience:

  • Pain during bowel movements: You may feel a stinging or burning sensation when having a bowel movement.

  • Bleeding: You may notice blood in your stool or on the toilet paper after wiping.

  • Discharge: A yellowish or greenish discharge may be present, especially if you have an infection.

  • Itching or discomfort: You might feel itching or discomfort around the anus.

Treatment

The good news is that most anal fissures can be treated with self-care measures and medical interventions.

Here are some treatment options:

  • Dietary changes: Drinking plenty of water, and avoiding foods that cause constipation can help alleviate symptoms.

  • Topical creams or ointments: Applying a topical cream or ointment containing hydrocortisone, lidocaine, or glycerin can help reduce inflammation and pain.

  • Sitz baths: Soaking in a warm bath with baking soda or Epsom salt can help reduce discomfort and promote healing.

  • Laxatives: Taking laxatives to soften stool can make bowel movements less painful.

  • Surgery: In severe cases, surgery may be necessary to repair the tear or cut.

Prognosis

The prognosis for anal fissures is generally good. With proper treatment and self-care, most people can experience relief from symptoms within a few weeks. However, it is essential to seek medical attention if you experience:

  • Severe pain or bleeding

  • Fever or chills

  • Abscesses or fistulas

By understanding what an anal fissure is, how it occurs, and the treatment options available, you will be better equipped to manage your symptoms and promote healing.

Remember, it is essential to consult with a healthcare professional if you suspect you have an anal fissure. They will assess your condition and provide personalized guidance on the best course of treatment for you.

Healing at home

Achieving quick healing of a fissure requires ensuring that the cut in the skin closes and has an opportunity to heal without reopening.

To accomplish this, it is essential to maintain regular bowel movements that meet the following criteria:

  • Regularity: Aim for one bowel movement per day.

  • Size: Strive for small, thin stools that pass easily.

  • Consistency: Aim for soft, mushy, and fatty stools instead of hard and dry ones.

It is important to note that everyone’s body and digestive system are unique, making it impossible to adopt a one-size-fits-all approach to achieve the ideal bowel movement. However, the following guidelines will provide valuable insights.

Healing a fissure is a prolonged process. After a few days, the fissure should be healed enough to alleviate pain, provided that bowel movements remain small and well-lubricated. Although the risk of the fissure reopening remains high after a week, the likelihood decreases significantly by two weeks. At this point, large bowel movements may still cause a recurrence though.

By three weeks of pain-free bowel movements, the healing process should be largely complete, and the danger of the fissure reopening is relatively low.

Position yourself well

When sitting on a conventional toilet, your body is at an angle that can cause a kink in the rectum, making bowel movements more challenging.

ADA-compliant toilets are designed to be higher to facilitate easier use for senior or handicapped individuals. However, this design may not cater to everyone’s needs. For those of average height, it may feel as if their feet barely touch the ground, resulting in a more than 90-degree angle that can hinder bowel movements.

A simple yet effective solution is to adopt a squatting position while on the toilet. This practice emulates the natural posture our ancestors used for centuries before the invention of modern toilets.

By adopting a squatting position, you can reap numerous benefits:

  • Natural alignment: Squatting straightens out the rectum, allowing for smoother and more efficient bowel movements.

  • Ease of elimination: The squatting position relaxes the puborectalis muscle, which helps to straighten out the rectum and align it with the anal canal. This alignment enables waste to pass through the colon and out of the body more easily.

  • Prevention of constipation: Squatting can help prevent constipation by promoting complete evacuation of the bowels. When waste is fully expelled, it reduces the risk of fecal buildup in the colon, which can lead to constipation and other digestive issues.

  • Reduced straining: Squatting may reduce the need to strain during bowel movements, lowering the risk of hemorrhoids, pelvic floor issues, and related problems.

Using a footstool is a simple and cost-efficient method to ease your bowel movements:

To use a footstool, place it in front of the toilet and position your feet on it while sitting on the toilet seat. This elevates your knees above your hips, simulating a squatting position.

Warning

While using a footstool can be beneficial for most individuals, it may not be suitable for everyone, particularly those with mobility issues or certain medical conditions. Exercise caution and discontinue use if you encounter any problems.

Protection during bowel movement

An anal fissure is a wound that requires protection during bowel movements. The primary goal in the healing process is to prevent the reopening of the wound, which can occur when straining, having large or hard stools, or engaging in other behaviors that cause stretching and irritation.

To support bowel movements while protecting the wound, it is essential to lubricate the anus thoroughly.

Two items are necessary for this purpose:

Before a bowel movement:

  1. Put a disposable finger glove on your index finger.

  2. With the gloved index finger, apply a glob of Vaseline (about the size of a chickpea).

  3. Insert finger with glob of Vaseline into your anus and spread the Vaseline around the entire circumference of your anus and outside, ensuring that stool does not come into contact with the skin.

  4. Remove your finger from your anus and dispose of the glove.

  5. Wash your hands.

After your bowel movement, wipe your bottom gently until clean but avoid over-wiping, which can irritate sensitive skin. Note that some Vaseline may remain. It is not necessary to remove all of it as it provides protection for the wound and prevents chafing while walking.

Tip

Wear older underpants. Vaseline may stain them. If you need to wash your underpants, a washing machine should be able to clean them effectively.

Avoid excessive wiping, which can irritate sensitive skin and will be counter-productive. If you have Witch Hazel medicated wipes at your disposal, you can use those as Witch Hazel has an astringent effect. However, the protecting effect of Vaseline should be enough so that you could use normal toilet paper as well.

Tip

Lubricating before bowel movements can also protect against spicy foods. If you do not lubricate, avoid consuming spicy food altogether. This will help prevent discomfort and irritation.

Stool consistency

Stool consistency (as well as shape and size) can be classified using the Bristol Stool Scale (BSF) ranging from Type 1 (separate hard lumps) to Type 7 (watery, no solid pieces):

Type 1: Separate hard lumps

  • Small, hard pellets with a rough surface

  • Often difficult to pass

Type 2: Sausage-shaped but lumpy

  • Longer and more cylindrical than Type 1, with some lumps

  • Still relatively firm

Type 3: Like a sausage but with cracks on the surface

  • Sausage-like shape, but with visible cracks or fissures

  • May be slightly softer than Type 2

Type 4: Smooth and compact

  • Regular, smooth shape with a consistent texture

  • Often considered the "ideal" stool consistency

Type 5: Soft blobs with clear-cut edges

  • Softer and more rounded than Type 4, with distinct edges

  • May be slightly runny or drippy

Type 6: Soft, fluffy pieces

  • Very soft and fragile, like cotton wool

  • Often difficult to form a cohesive stool

Type 7: Watery, no solid pieces

  • Extremely loose and watery stool, with no visible solid pieces

  • May indicate gastrointestinal issues

The goal for easy passing of stools is Type 4, which can be achieved by maintaining a balanced diet, staying adequately hydrated, and having a healthy gut microbiome.

Types 1 to 3 indicate constipation, making it more challenging to pass stool. Moreover, they can hinder the healing process of an anal fissure.

Several strategies are available to shape stool consistency.

Consume vitamin C first thing in the morning

Take 1000 mg of vitamin C on an empty stomach before consuming any food - this is crucial. Typically, within 30 to 60 minutes, a bowel movement will occur.

Similar to magnesium citrate, vitamin C releases water into the intestines, softening stool and making it easier to pass.

A convenient way to consume vitamin C is through Emergen-C, containing 1000 mg per packet.

Note

1000 mg vitamin C is a starting point. If you experience loose stools, reduce the dosage. If your stools are too hard, increase the amount.

Reduce fiber intake

Adequate dietary fiber intake is often recommended for promoting regular bowel movements and soft stools. However, fiber (such as psyllium husk) can bulk and enlarge stool, supposedly making them easier to pass. This appears illogical, as large stools are actually harder to pass.

Therefore, reducing rather than increasing dietary fiber intake is recommended while healing an anal fissure.

For the same reason, it is best to avoid eating hard foods that cannot be chewed into perfectly soft mush. Nuts and corn are examples of such foods.

For more information on this topic, visit the comprehensive and well-written Gut Sense website at https://www.gutsense.org/.

Increase healthy fat intake

Boosting healthy fats in your diet may help soften your stool and make it easier to pass.

Examples of healthy fats include:

  • Real butter

  • Olive oil

  • Coconut oil

  • Ghee

Warning

Avoid all seed oils, as they are often highly processed and unnatural.

Fat is calorie-dense, meaning it can help you feel fuller more quickly. In turn, this reduced caloric intake may also reduce the amount of stool produced, making it easier to pass.

Consume magnesium citrate

Magnesium citrate helps regulate digestion by prompting the intestines to release water into the stool, making the stool softer and easier to pass.

For this purpose, you can use Natural Vitality Calm.

Be aware that even small amounts, such as half a teaspoon daily, may soften stool to diarrhea-like consistency over the course of 2-3 days, depending on your body’s sensitivity.

Warning

If you are sensitive, it may take a few days after stopping consumption for very soft stool consistency to return to normal.

Rectal enemas

With rectal enemas, a liquid is inserted into the rectum to flush out its contents. Using such enemas makes sense when you are working to improve your stool consistency through dietary changes and your Bristol Stool Form (BSF) type is between 1 and 3.

A lubricant laxative enema like the Fleet Mineral Oil Enema is easy to use, and the lubrication makes it easier to pass hard stool.

Tip

Half of a 4.5 fl oz bottle may be sufficient. Experiment with the amount you use.

Warning

Leakage issues should be rare. However, wearing older underwear and sitting on the toilet before passing gas are good strategies for avoiding accidents.

Lubricant laxatives

Lubricant laxatives primarily consist of mineral oil, which coats the intestines and helps retain water within stool, making it softer and easier to pass.

Dosage varies depending on individual circumstances.

It may be necessary to take up to 8 teaspoons or more, approximately 6-8 hours prior to a planned bowel movement.

Warning

Coating the intestines can potentially interfere with the absorption of vitamins, nutrients, and other medications.

Small droplets of mineral oil may enter the lungs when swallowing, which is undesirable.

High doses of oil may cause leakage from the rectum, potentially soiling clothing.

Due to these potential risks and side effects, lubricant laxatives are generally discouraged and should only be considered as a last resort.

Aiming for one bowel movement per day

While some sources claim that having a bowel movement every few days is normal, it is essential to note that if you consume food daily, this is not normal. Digestive transit times can vary between individuals and depending on the food consumed. However, when you put something into your body three times a day, waste should be eliminated at least once a day.

Failure to do so may lead to constipation, which in turn increases the risk of developing hemorrhoids or anal fissures due to straining to expel hard and lumpy stool.

When healing an anal fissure, it is crucial to maintain regular bowel habits to prevent setbacks caused by large or hard stools that can reopen the wound.

Ideally, aim for a single bowel movement per day to give your rectum time to heal undisturbed. The strategies outlined in previous sections provide tools to help you achieve this goal.

For instance, if your stool is too hard and irregular, taking vitamin C in the morning may aid regularity and soften stool. Conversely, if your stool is too soft or bowel movements occur too frequently, reducing foods and drinks that may trigger these issues based on your personal experience can be helpful. For individuals with sensitive digestion, coffee is a common culprit.

At night

At night, it is recommended to lubricate your anus before going to bed in order to promote healing and reduce itching.

For instructions on how to do so, please refer to Protection during bowel movement.

An alternative to Vaseline is Doctor Butler’s Advanced Hemorrhoid & Fissure Ointment. This ointment not only promotes healing but also reduces pain and itching.

Muscle relaxation

With an anal fissure, the exposed internal sphincter muscle beneath the tear contracts in spasm, causing pain. Additionally, it pulls the edges of the fissure apart, impeding wound healing.

To promote relaxation and aid in healing, soaking in warm water for 10 to 20 minutes, especially after bowel movements, is crucial.

A sitz bath is an effective way to achieve this. You can find a sitz bath online like this Sitz Bath for Toilet or use your bathtub if you prefer. Using a tub may be a convenient option if you are unsure about committing to a sitz bath.

Beyond sitz baths, relaxation can also be promoted by gentle manipulation of the anus with a finger or small butt plug. However, we recommend waiting at least two weeks after healing has begun without any reopening of the wound before attempting this method.

After your sitz bath:

  • Put on a finger glove and apply Vaseline to your index finger. Then, slowly and carefully insert it into your anus.

  • Perform a slow swirling forward and backward motion for one minute, followed by holding still for one minute.

  • Remove your finger and clean up.

  • If you experience any pain during this process, stop immediately.

Alternatively, consider investing in an Anal Plug Training Set instead of using your fingers. The smallest plug is recommended, paired with a water-based lube like Astroglide. This method can be more comfortable and can be worn while taking a sitz bath.

Disclaimer

Information on this page is for general information purposes only. You should not use it as a basis for making any business, legal, medical or any other decisions. Consult a professional for advice before making any decisions.