3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

Anal Fissure

Anal Fissure

What is an anal fissure?

An anal fissure, also known as an anorectal fissure in Singapore, is a small cut or tear in the delicate lining of the anus. The cut or tear in the skin results in pain and, in some cases, causes bleeding during and after bowel movements. In more severe cases, anal fissures can be deep enough that they expose the muscle tissues.
Anal fissures are categorised into two types:
  • Acute anal fissure: acute anal fissure refers to anal fissures that last less than six weeks.
  • Chronic anal fissure: chronic anal fissure refers to anal fissures that last more than six weeks.
  • Anorectal Fissure

    Anal fissure is a common condition that is often caused by excessive straining during bowel movement.

    What are the common causes of anal fissure in Singapore?

    The most common cause of an anal fissure is anal trauma. Anal trauma can occur due to various causes, such as:

    Constipation:

    constipation is usually accompanied by straining and the passing of hard stools. This can cause a tear in the delicate lining of the anus.

    Anal sex/trauma:

    inserting anything into the anus can tear the lining in the anus and result in an anal fissure.

    Chronic diarrhoea:

    chronic diarrhoea can irritate the lining of the anus and result in an anal fissure.

    Pregnancy and childbirth:

    pregnancy increases the risk of constipation, which can cause an anal fissure. Additionally, childbirth involves an intense amount of pressure and straining, which may tear the lining of the anus.

    Medical conditions:

    some medical conditions, such as inflammatory bowel disease (IBD), haemorrhoids, irritable bowel syndrome (IBS), and sexually transmitted diseases (STDs), can result in anal fissures.

    What are the symptoms of an anal fissure?

    The symptoms of an anal fissure vary and often depend on the severity and whether it is acute or chronic.
    The exact causes of anal fissures can be difficult to determine; it is best to seek medical advice if you have been experiencing changes in your bowel movements.

    Symptoms of acute anal fissures are:

  • Bad-smelling discharge
  • Tear in the anus
  • Bleeding during or after bowel movements
  • Pain during bowel movements
  • Symptoms of chronic anal fissures include:

  • Painful bowel movement with the absence of blood
  • Skin tag at the end of the anal fissure
  • Itch or irritation around the anus
  • Painful bowel movement is a common symptom of anal fissures.

    Who is at risk of developing an anal fissure in Singapore?

    Certain risk factors can increase a person’s likelihood of getting anal fissures, including:
  • Consuming a low-fibre diet
  • Chronic diarrhoea
  • Constipation or trying to pass hard stools
  • Inflammatory bowel conditions that are associated with the anal area
  • Vaginal childbirth
  • Obesity or being overweight
  • These risk factors increase the pressure and strain on the anus, which can cause tears in the lining, resulting in an anal fissure.
    These risk factors increase the pressure and strain on the anus, which can cause tears in the lining, resulting in an anal fissure.
    An anoscope may be used to inspect the anal canal when diagnosing anal fissures.

    How are anal fissures diagnosed?

    Anal fissures in Singapore are often diagnosed through a physical examination to look for visible tears in the anal region. An acute anal fissure resembles a paper cut, while a chronic anal fissure would likely be a deeper tear. Typically, a physical examination is all that is needed to confirm anal fissures.
    However, your doctor may recommend undergoing several other diagnostic procedures to confirm the underlying cause of anal fissures. These tests may include:

    Anoscopy:

    an anoscopy is a test that uses an anoscope to inspect the anal canal and rectum to diagnose anal and rectum conditions.

    Colonoscopy:

    a colonoscopy involves inserting a long, flexible tube into the rectum to inspect the colon.

    Flexible sigmoidoscopy:

    a flexible sigmoidoscopy involves inserting a thin, flexible tube with a built-in tiny camera and light into the rectum to inspect the bottom part of the colon.

    What are the treatment options for anal fissures in Singapore?

    Depending on its severity, causes, and whether the anal fissure is acute or chronic, treatment options will vary. However, common treatment options for naal fissures include:

    Topical medications:

    topical medications, which may be over-the-counter or prescribed, can reduce inflammation and alleviate symptoms such as pain.

    Laxatives or stool softeners:

    one of the common causes of anal fissures is constipation or straining to pass hard stools. Therefore, laxatives or stool softeners may be prescribed to make stools soft and easy to pass.

    Lifestyle changes:

    consuming a high-fibre diet can reduce constipation and, in turn, reduce the risk of anal fissures.

    Botulinum toxin injections:

    these injections work to relax the muscle and enhance blood flow in the area, which promotes healing of the anal fissure.

    Medications:

    individuals with tight anal sphincter muscles may be prescribed calcium channel blockers or nitrates, which relax muscles and promotes healing.

    Lateral internal sphincterotomy:

    a lateral internal sphincterotomy is a surgical procedure where a small incision is made in the anal sphincter muscle. This reduces strain and pressure.

    Fissurectomy:

    surgical removal or a fissurectomy of the fissure may be conducted if other conservative treatments have failed or if the anal fissure is too large.

    Frequently Asked Questions

    Yes, anal fissures can come back, primarily if the underlying factors that contributed to their development are not addressed. Recurrence of anal fissures is relatively common, particularly if predisposing factors such as constipation, diarrhoea, or anal trauma persist.

    With the appropriate treatment, acute anal fissures typically take a few weeks to heal. However, chronic anal fissures can take several months.

    One of the ways to prevent anal fissures is by eating a high-fibre diet and staying hydrated. However, if you have a family history of anal and rectum-related diagnoses or are experiencing other symptoms, it is best to speak with a doctor to have those symptoms checked.

    Anal fissures are sharp cuts in the anal lining, while anal fistulas are abnormal canals that form in the lining of the anus. Additionally, haemorrhoids are swollen veins in the rectum.

    Location

    Colorectal Care Specialists (CRCS)

    3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

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