Blood in Stool (Hematochezia) / Rectal Bleeding

1. Anal Fissure (+)

CAUSES

Anal fissure often occurs due to the passage of hard or large stools. Frequent diarrhea or chronic constipation can also result to the tearing of the skin around the anus. Other common causes for developing an anal fissure includes:

. Crohn’s disease or inflammatory bowel disease (IBD) that causes inflammation of the anorectal area.

. Straining episodes during child birth.

. Spastic or overly tightness of the anal sphincter muscles.

. Reduced or insufficient blood flow to the anorectal area.

. Constipation and excessive straining during bowel movements.

In rare cases, the following diseases may also cause an anal fissure:

. Anal cancer

. Tuberculosis

. HIV

. Herpes

. Syphilis

RISK FACTORS

There are various factors that increases the risk of getting an anal fissure. They are:

. Infancy: Infants in their first year are prone to developing anal fissure. However, experts are not sure of the reason behind the development in infants.

. Older Adults: Over the years, the veins of the body tends to become clogged due to accumulated fat, cholesterol and many other similar reasons. This results to inefficient flow of blood. Anal fissure can develop when blood flow in the anorectal area is reduced.

. Constipation: It remains as one of the leading reasons for developing anal fissure due to the episodes of straining involved during bowel movements and passage of hardened stools that increases the risk of tearing.

. Childbirth: Anal fissures are common in women upon the delivery of their baby.

. Crohn’s disease: The medical disorder causes chronic inflammation of the intestinal tract which may result to a lining rupture in the anal canal.

. Anal intercourse

SYMPTOMS

There are several symptoms that indicates for an anal fissure disease. They include:

. A visible rupture of the skin around the anus.

. Growing of a lump of skin or skin tag near the anal fissure.

. Severe pain may be felt during bowel movement which is localized in and around the anal area.

. Blood patches on stool or on the tissue paper used for wiping.

. Presence of itching or burning localized in the anal area.

COMPLICATIONS

There can be several issues or complications possible to arise following the development of anal fissures. These include:

. Inability to heal: Chronic anal fissures may fail to heal in less than 6 weeks’ time and needs further treatment. An unhealed anal fissure requires medication to reduce pain; or surgery for the removal/repair of the fissure.

. Recurrence: A patient diagnosed with anal fissure is more prone to suffer another one.

. Tear extending to closed muscles: Anal fissure may expand up to the internal anal sphincter (ring of muscle) which holds the anus tightly. This extension of the anal fissure makes the healing process more complicated.

PREVENTION

Total prevention to the occurrence of anal fissures may not always be possible. However, the risk of developing one can be prevented by adopting the following preventive measures:

. Having the anal area clean and dry.

. Gentle cleaning of the anal area with warm water and mild soap.

. Prevention of constipation by eating fibre rich foods, drinking enough fluids and practicing regular exercise.

. Immediate treatment of diarrhea.

. Frequent changing of diapers in infants.

DIAGNOSIS

In order to diagnose anal fissure, the doctor may perform rectal examination digitally. This involves examining the surrounding area of the anal canal either by using an anoscope (short, lighted tube) or simply inserting gloved finger into it.

. Rectal Exam: The rectal exam helps reveal the fissure’s exact location and provides clues about its occurrence. A fissure on either side of the anal’s opening is a sign of a medical disorder like Crohn’s disease. Further treatment may be recommended by the doctor when other underlying conditions are found.

. Colonoscopy: The entire colon is inspected by inserting a flexible and light tube into the rectum. This test is recommended for people older than 50 years of age, has risks of colon cancer, experiencing abdominal pain, diarrhea, etc.

. Flexible sigmoidoscopy: A flexible tube carrying a tiny video camera is inserted at the bottom of the colon. This test is done when there is no risk factors such as colon cancer or intestinal disease.

TREATMENT: NON-SURGICAL

Doctors often recommend the following non-surgical treatment methods:

. External application of Nitrogylcerine: This helps in increasing blood flow to the fissure in order to promote healing, and also helps in relaxing the closed muscle or anal sphincter. There could be some side effects such as severe headache.

. Anesthetic creams: Application of lidocaine hydrochloride (Xylocaine), a topical anesthetic cream which helps in pain relief.

. Botox Injection: Type A Botulinum toxin injection paralyzes the anal sphincter muscle which relaxes the spasms.

. Blood pressure medications: Cardizem (diltiazem) or Procardia (oral nifedipine) helps in relaxing the anal sphincter. They can be taken orally or can be applied externally.

TREATMENT: SURGICAL

The doctor may recommend for surgical treatment of the anal fissure when it has become chronic and unable to heal with the use of medication or other non-surgical treatments.

A surgical procedure known as LIS or lateral internal sphincterotomy may be performed to promote healing, where a small portion of the anal sphincter muscle is cut resulting to a reduction in pain and spasm. It has been found that in the treatment of chronic fissure, surgery is very effective than any other available medical treatments.

HOME REMEDIES

Most of the anal fissures don’t need expensive and extensive treatment. There are several home remedies available that can promote healing and ease against the uncomfortable symptoms. These includes:

. Using stool softners.

. Drinking enough fluids.

. Eating fibre rich foods such as vegetables and fruits, along with fibre supplements.

. Application of nitroglycerin to the anus to increase blood flow to the anorectal area; or application of hydrocortisone cream like Cortizone 10 to reduce inflammation.

. Taking sitz bath or warm bath to relax the anal muscles. It also helps relieve irritation and increases the flow of blood to the anorectal area.

. Application of pain relievers to the anus such as topical lidocaine which eases the discomfort in and around the anal area.

VISITING A DOCTOR

Visiting an specialized doctor for the particular disease should be considered. In order to achieve successful treatment of anal fissures, look for experienced doctors who can ensure you quality treatment for they have a successful recovery record with outstanding results.

Visit a Colorectal surgeon for chronic treatment of anal fissures. Two preferred departments for treating anal fissure are Gastroenterology and Hepatology, and Colon and rectal surgery.

2. Hemorrhoids (+)
3. Anal Fistula (+)
4. Gastroenteritis (+)
5. Peptic Ulcer (+)
6. Diverticular Disease (+)
7. Bowel Cancer (+)
8. Crohn’s Disease (+)
9. Angiodysplasia (+)
10. Esophageal Varices (+)