Do You Feel Pain When Passing Stool? (Anal Fissure)

What is anal fissure?

Anal fissure is the most common cause of painful defecation (opening bowels). Most times, it is also associated with bleeding. It is a small cut in the anal canal up to the skin.

Pain while passing motion which lasts up to a few hours afterwards is the most common complaint. This is usually associated with constipation (passing hard stool/pushing hard to open bowel). At times, it is seen after an episode of loose motion.

***Pain while passing stool is never caused by piles/hemorrhoids.***

How is such severe pain caused?

The easiest way to understand is if you sustain a small cut while cutting vegetables, pain will persist until the cut has healed. The pain gets aggravated whenever anything touches the wound, including clothes. Similarly, the pain gets stimulated when the stool passes through the anal canal touching the fissure.

What is the treatment for anal fissure?

When treated appropriately in the initial stages, fissure heals up to 75 percent with medicines. Longer the duration, less likely it is to heal with creams and might need simple surgery to relax the sphincters so that the fissure can heal.

Treatment includes the following:

1. The main stay of treatment includes keeping stools soft. This is usually achieved by laxatives during the period of anal fissure, but in the long run by eating more fruits and vegetables, drinking at least three litres of water in a day and exercise.
2. Local anesthetic cream applied 20 minutes before passing the motion will help in relieving the pain.
3. Second cream (2 percent Diltigesic) helps to relax the muscle that helps in healing the fissure. With this treatment, usually 50–60 percent of fissures heal.

The next step should be an injection of Botox into the sphincters. The injection is expensive and the patient should be able to afford it. It will increase the chances of healing up to 75–80 percent. This is more so recommended in females as they have weak and small sphincters compared to men, and moreover, they can also be damaged at the time of vaginal delivery. The Botox injection causes only temporary relaxation of muscles (up to 6 months) so that the fissure can heal.

Patients in whom the fissure does not heal by conservative management require a simple surgery (lateral sphincterotomy). This will reduce the pain significantly within 24 hrs.

What is chronic anal fissure?

 Any anal fissure that has not healed even after 6 weeks is called chronic anal fissure. Conservative measures are unlikely to work, and patients might need surgery most of the times.

What are the complications of anal fissure?

A small skin tag (sentinel skin tag) can develop in chronic fissures. Some patients may experience itching.

Fissure will never lead to cancer.