Thomas P. Sokol, MD received his medical degree from the University of Health Sciences/The Chicago Medical School in 1980. He went on to his general surgical residency at Harbor/UCLA Medical Center and then to the Carle Clinic/ University of Illinois for Fellowship Training in Colon and Rectal Surgery.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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; however, 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. Moreover, constipation can result in
the passage of a larger, harder stool that causes further trauma and makes the
fissure worse. The pain also can affect urination by causing discomfort when
urinating (dysuria), frequent
urination, or the inability to urinate. Bleeding in small amounts, itching (pruritus ani), and a
malodorous discharge may occur
due to the discharge of pus from the fissure.
As previously mentioned, anal fissures commonly bleed in infants.
How are anal fissures diagnosed and evaluated?
A careful history usually
suggests that an anal fissure is present, and gentle inspection of the anus can
confirm the presence of a fissure. If gentle eversion (pulling apart) the edges
of the anus by separating the buttocks does not reveal a fissure, a more
vigorous examination following the application of a topical anesthetic to the anus
and anal canal
may be necessary. A cotton-tipped swab may be inserted into the anus to gently localize the
source of the pain.
An acute anal fissure looks like a linear tear. A chronic
anal fissure
frequently is associated with a triad of findings that includes a tag of skin at
the edge of the anus (sentinel pile), thickened edges of the fissure with muscle
fibers of the internal sphincter visible at the base of the fissure, and an
enlarged anal papilla at the upper end of the fissure in the anal canal.
If rectal bleeding is present, an
endoscopic evaluation using a rigid or flexible viewing tube is necessary to exclude
the possibility of a more serious disease of the anus and rectum. A sigmoidoscopy
that
examines only the distal part of the colon may be reasonable in patients younger
than 50 years of age who have a typical anal fissure. In patients with a family
history of colon cancer or age greater than 50 (and, therefore, at higher risk
for colon cancer), a colonoscopy that examines the entire colon is recommended.
Atypical fissures that suggest the presence of other diseases, as discussed
previously, require other diagnostic studies including colonoscopy and upper
gastrointestinal (UGI) and small intestinal X-rays.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Hemorrhoid is an enlarged vein in the walls of the anus and sometimes around the
rectum, usually caused by untreated constipation, but occasionally associated
with chronic diarrhea. If untreated, hemorrhoids can
worsen, protruding from the anus. Also known as piles.
Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
Laxatives for treatment of constipation include over-the-counter preparations such as bulk-forming laxatives, stool softeners, lubricant laxatives, stimulant laxatives, saline laxatives, enemas and suppositories. Some over-the-counter laxatives are not recommended for patients with specific diseases or conditions. Some laxatives may have negative adverse effects if taken over long periods of time.
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