What are the symptoms of anal fissures?
An anal fissure usually manifests itself through severe, stabbing pain in the anus. The pain in the anus during and after bowel movements can greatly restrict the daily life and quality of life of those affected. As a result of a tear in the anus, stool passage is only possible with pain. There are reports of very painful defecation, which can set off a vicious cycle. Patients often report pain radiating towards the tailbone. The intensity of the pain naturally also depends on the size and depth of the tear in the anal mucosa. The spectrum ranges from small micro-tears of the mucosa to larger and deeper fissures. Many affected people consequently hold back stool to prevent the severe, stabbing pain. However, this behavior promotes further hardening of the stool, which can further worsen or enlarge the tears in the anal mucosa. Ultimately, this makes going to the toilet even more painful. Often, the complaints persist after the toilet visit in the form of a burning constant pain.
Additionally, the intense pain in the anus leads to spasms of the sphincter muscle and anal area. This further intensifies the symptoms of the anal fissure. Due to the spasm of the sphincter muscle, the surrounding tissue is less well supplied with blood, so the tears in the anal mucosa or anus heal poorly. This not only leads to poorer wound healing in the anal region but also increases the risk of infection. Consequently, there is a risk that an acute anal tear may develop into a chronic anal fissure. The chronicity of the tear makes the treatment of anal fissures significantly more difficult and complicated and can even lead to an anal fissure surgery. If you have symptoms of an anal fissure, consult your doctor as soon as possible. Read more about diagnosis and examinations in the blog post on anal fissure doctor or about various surgical techniques for anal fissures in the blog post on anal fissure surgery.
The spasms of the sphincter muscle can possibly cause further mucosal tears. Read more here about the causes of anal tears. If the tear extends deeper to the internal sphincter muscle, it is possible that the connective tissue around the muscle increases and hardens over time due to the strong spasms. This skin thickening mainly occurs in chronic anal fissures. Doctors refer to this as a sentinel fold or marisca.
If affected individuals hold back stool out of fear of pain, this can lead to chronic constipation (obstipation). Patients also often report anal itching, anal burning, moisture and mucus secretion from the wound in the anus, as well as bright red blood deposits on the stool or blood on the toilet paper. Read more here about bleeding with an anal fissure.
What are the symptoms of an acute anal fissure?
The acute anal fissure is usually accompanied by a sharp, stabbing, or burning pain during bowel movements. This pain usually subsides quickly after the bowel movement. Other common symptoms of an acute anal fissure are bright red, fresh bleeding. The intensity of the bleeding with an anal fissure ranges from a blood streak on the toilet paper to blood splashes in the toilet. The actual blood loss is usually small and generally considered not dangerous. Nevertheless, blood in the stool greatly unsettles many patients. If you experience symptoms of tears in the anus, be sure to discuss these complaints with your trusted doctor. Read more about diagnosis and examinations in the blog post on anal fissure doctor. Affected individuals do not necessarily have to experience both main symptoms simultaneously; these two symptoms can also occur separately.
Depending on the severity of the anal fissure, the outer extension of the acute fissure is usually visible during examination even with slight spreading of the buttocks. The majority of anal fissures are located in the midline, and 75-90% on the side facing the tailbone. Depending on the cause of the anal fissure, infections such as HIV, tuberculosis, and syphilis should also be ruled out during diagnosis and subsequent examination by the doctor. Tumor diseases or chronic inflammatory bowel diseases such as Crohn's disease are also among the various causes of anal fissures. Your medical care may include further diagnostics with serological and microbiological tests as well as a colonoscopy with tissue sample collection. Read more about diagnosis and examinations for anal tears in the blog post anal fissure doctor.
What are the symptoms of a chronic anal fissure?
If the symptoms of an anal fissure persist for several weeks and vary in intensity, the anal fissure may already be classified as chronic. Externally visible signs of a chronic anal fissure are skin thickenings or skin folds, called sentinel folds or marisca. Some patients feel a palpable hardening. Since these typical symptoms also occur in other proctological diseases, an accurate diagnosis and examination of the anal fissure is important. In a chronic anal fissure, the pain during bowel movements is often less pronounced, but an itchy, moist ulcer often forms at the affected site. Typical is also a skin thickening, the sentinel fold or marisca. In more severe cases, an anal fistula may also form, which affects the sphincter muscle with the fistula tract. Chronic anal fissures sometimes lead to anal fissure surgery if conservative measures in the treatment of anal fissures such as ointments, creams, sitz baths, and suppositories are not sufficiently effective. Read more here about the benefits and dosage when using suppositories for treating anal fissures.
How do acute anal tears and chronic anal fissures differ?
The main differences between acute and chronic anal fissures lie in the duration of symptoms, the extent of tissue changes in the anal canal, and the intensity of the fissure symptoms. The acute form of the anal fissure occurs quite frequently and should generally heal after four to six weeks at the latest with consistent treatment of the anal tear. Read more here about accelerating the healing of anal fissures. The longer the fissure persists or the deeper it is, the greater the risk of further tissue changes. If the ulcer deepens, scar changes are much more likely in a chronic fissure. This can lead to a so-called sentinel fold, also called a marisca. A marisca is a skin thickening that itself poses no direct health risk. However, complaints can be aggravated by a marisca because it makes thorough anal hygiene more difficult. Chronic anal fissures often also lead to benign connective tissue nodules called anal fibromas, or as a result of inflammation in the anus and abscess formation, also anal fistulas with deep and more complicated fistula tracts. Such complications can also be a reason for anal fissure surgery.
Find more general information here about the treatment of anal fissures or which measures in everyday life and lifestyle can help you prevent anal fissures.
