How do you know you have an anal fissure?

November 10th, 2009

Hopefully, you have read my post on what causes anal fissures.  If you have had one or more of the conditions recently or repeatedly, and have pain or bleeding when passing a stool, then you could have an anal fissure.

The pain can vary from mild to excruciating, and the blood can vary from a few drops on the toilet paper, to bright-red water in your toilet (if the blood isn’t bright red but darker (brownish), then you may have a problem higher up in your digestive tract).  If you have anal fissures, you’ll probably have itching during the early stages as well.

The easiest way to confirm that you have an anal fissure is to visit your physician, preferably a gastroenterologist (GI) or a colorectal surgeon (CRS) because they are specialists and less likely to misdiagnose you.

As an aside, if you are embarrassed about such conditions (like I was), let me give you some tough love right now – “get over it fast!”.  Having that mentality will cause you a lot of needless pain and suffering, and will throw up obstacles on your path to healing, so please don’t make that same mistake that I did.  Make sure you get the expert medical advice as soon as you can.  Even if you do decide not to follow their advice completely, you may need them to prescribe medications to help heal your fissure.

Hemorrhoids share many of the causes and symptoms of anal fissures, and sometimes physicians will incorrectly diagnose you with hemorrhoids – this is why a physical inspection is necessary.  In the most basic inspection, the physician will separate the buttocks to do a visual inspection.  The physician may also insert a gloved finger (with lubrication and anesthetic if there is a lot of pain) to feel around the anal canal.  This may be all that is necessary to determine whether hemorrhoids and/or anal fissures are present.

The physician may want to conduct more extensive tests to confirm the symptom or another more serious underlying cause, which can include:

  • Anoscopy:  The physician uses a device to view the anal canal
  • Proctoscopy: The physician uses a device to view the lower rectum
  • Sigmoidoscopy: The physician uses a device to go even further (view the sigmoid colon)
  • Colonoscopy: The physician uses a device to inspect the entire colon, and is typically used to screen for colon cancer

The last three of the procedures above are listed in order of  increasing thoroughness, but also increasing preparation and discomfort.  In my case, I had a colonoscopy done, but really, it was overkill.  I had to fast and take several enemas (chemicals that force you to have diarrhea to empty your bowels) so that the colon could be empty for the procedure.  When you have an anal fissure, this can be very painful.  If you are 50 years of age or older and need to screen for colon cancer anyway, then perhaps a colonoscopy is worth it, but knowing what I know now, I would not want to go further than an anoscopy without a really good reason.

If you insist on a at-home diagnosis, you can try squatting over a mirror and separating your buttocks to see whether you have a cut or tear.  If the fissure is not visible (it’s internal), you can gently insert a finger with lubrication (such as petroleum jelly or Astroglide) to feel around.   Be sure to practice good hygiene – thoroughly wash your hands before and after with (antibacterial) soap!  You can use a latex glove if you like, but I find it more difficult to feel the fissure, and there are some  people that have latex allergies that can irritate the fissure as well.

Hemorrhoids will feel like round bulges, and fissures will generally hurt/burn more and feel like a cut in and around the anal sphincter muscles.  Note that chronic fissures can develop what’s called a sentinel pile or a skin tag, which isn’t really a hemorrhoid but looks a little like one.  That’s why it’s important to get a medical expert make a diagnosis.

OK, so bottom line – do a preliminary exam if you want to, but if you have pain and bleeding, head to see your medical specialist right away.  The sooner you get the diagnosis confirmed, the sooner you can be on your path to being fissure free.

To your first step in being fissure free,

Uric Seefurs

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What causes anal fissures?

November 10th, 2009

Anal fissures are a very common condition, though exact numbers are hard to come by in scientific research because people are often embarrassed to talk about it.  I estimate that at least 1 in 5 people have had anal fissures.  These are very common in young children when they start to eat varieties of foods, although in children they tend to be acute (vs. chronic) and heal by themselves without intervention.

An anal fissure is caused by stress or trauma to the anal canal, and can be brought about by:

  • Constipation (passing a large hard stool)
  • Diarrhea
  • Childbirth
  • Inserting foreign objects in the anus (including anal sex)
  • Irritable bowel syndrome or other systemic health conditions

Existing research and my own experience suggests that people who develop anal fissures also literally have a tight ass!  This means that the anal sphincter resting rate is much higher than the average (it’s tense when it doesn’t need to be).

Generally, people who are worry-warts and who are stressed or tense (like me!) tend to be predisposed to this condition.  It’s a vicious cycle because the anal fissure will tend to add more stress to your life…so although it may not be easy, take steps to reduce stress immediately.  I will go into this in detail in another post, but in the meantime, try getting enough sleep, exercising (aerobic only – not weights!), and thinking positive thoughts.

To your stress-free life,

Uric Seefurs

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What are anal fissures?

November 2nd, 2009

Anal fissures are tears or splits at the terminal part of the large intestine is called the anal canal. The anal canal consists of two different muscles – the internal and external sphincter muscles.

The external sphincter can be controlled voluntarily.  This means that when you have to go to the bathroom to pass a stool, you can stop passing the stool by voluntarily contracting the external sphincter muscle.  Of course, you can only do this for so long until the muscle tires out and you have to “go”.

The internal sphincter is an involuntary muscle that cannot be controlled voluntarily.  In a normally functioning system, the internal sphincter automatically relaxes once there is enough stool in the bowel and opens to let a stool pass (unless you contract the external sphincter to stop it).

When you develop an anal fissure, the internal sphincter muscle goes into spasm.  The anoderm tissue that makes up this part of your body is very special and has a multitude of nerve endings - resulting in the pain and spasms once the anal canal is damaged.  Furthermore, once a stool is passed, the internal sphincter goes back to an abnormally high resting level of contraction, making it difficult for any damage to the anal canal to heal, and causing a vicious cycle of re-tearing every time a stool is passed.

If you are suffering from anal fissures, I know how terrible this condition can be.  In a future post, I will discuss the causes of anal fissures as well as steps you can take to start the healing process.

Wishing you recovery through understanding,

Uric Seefurs

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