Anal fissure: Usually treatable with ointments

Anal fissure: Usually treatable with ointments

An anal fissure is a tear in the anal skin. Such a tear is noticeable through pain during defecation and blood in the stool or toilet paper. Problems with bowel movements are often the cause. A chair that is too hard and the associated heavy straining can injure the sensitive skin in the anal canal. Acute anal fissures can usually be treated well with ointments or creams. Conversely, an operation may also be necessary for a chronic fissure.

Causes of an anal fissure

The skin in the anal canal – also known as the anoderm – is susceptible. If the skin tears and a long tear forms, this is called an anal fissure. The exact causes for developing such a fissure have not yet been clarified. However, the consistency of the stool seems to play an important role.

For example, the development of an anal fissure can be favoured by muscular straining during a bowel movement – for instance, in the case of constipation. Persistent diarrhoea and haemorrhoids can also hurt the anal skin. If the fissure occurs as a result of a chronic intestinal disease such as Crohn’s disease or ulcerative colitis, it is referred to as a secondary anal fissure.


Blood and pain as symptoms

If there is an anal fissure, this often manifests itself as severe, burning or stabbing pain when having a bowel movement. Itching, burning or oozing in the anal area can also be symptoms of an anal fissure. Bright red blood is often found on toilet paper or stool.

As a result of the pain during bowel movements, there may be a delayed bowel movement. However, this only hardens the stool and further irritates the wound. If the pain causes the sphincter muscles to cramp, the pain can increase even further. In addition, the anal skin is less well supplied with blood due to the cramped muscles.

Therefore, those affected must maintain their toilet rhythm as much as possible and break the cycle of pain.

Acute and chronic anal fissure

In the case of anal fissures, a fundamental distinction is made between an acute and a chronic variant. Acute fissures usually heal within a few days.

However, if anal fissure symptoms do not improve within a few weeks, you may have a chronic anal fissure. It is typical of a chronic fissure that a thickened skin fold forms on the anus (outpost fold). Fibromas – benign knots of connective tissue – and scarred rim walls can also develop around the ulcer.


Which doctor helps with an anal fissure?

Wenn Sie Blut im Stuhl haben, sollten Sie immer einen Arzt aufsuchen, um eine ernsthafte Erkrankung ausschließen zu lassen. Bei Verdacht auf eine Analfissur wenden Sie sich am besten zunächst an Ihren Hausarzt – er wird Sie vermutlich an einen Proktologen überweisen. Dieser ist Spezialist für Erkrankungen des Enddarms.

Der Proktologe wird eine Untersuchung des äußeren Analbereichs durchführen. Liegt eine Analfissur vor, kann er diese oftmals ohne weitere Untersuchungen erkennen. Ist dies nicht der Fall, muss er den After von innen austasten. Dies geschieht meist erst nach einer örtlichen Betäubung, da die Untersuchung ansonsten mit Schmerzen verbunden sein kann. Muss eine Spiegelung des Enddarms durchgeführt werden, erfolgt dies ebenfalls nur unter Betäubung.

Analfissur mit Salben und Cremes behandeln

Eine akute Analfissur lässt sich oftmals schon durch eine Regulation des Stuhlganges behandeln. Achten Sie darauf, viel zu trinken und genügend Ballaststoffe zu sich zu nehmen. Diese stecken unter anderem in Obst, Gemüse und Vollkornprodukten. Ebenso trägt regelmäßige Bewegung dazu dabei, die Verdauung anzukurbeln.

Gegen die Schmerzen beim Stuhlgang können lokal betäubende Salben oder Zäpfchen helfen. Unter Umständen kann der Arzt auch direkt in den Bereich der Analfissur ein Betäubungsmittel spritzen. Durch die örtliche Betäubung kann der Schmerzkreislauf unterbrochen und die Heilung gefördert werden.

Sowohl bei akuten, als auch bei chronischen Analfissuren sind außerdem Salben zur Therapie geeignet, die den Schließmuskel besser durchbluten und die verkrampfte Muskulatur entspannen. Sie enthalten in der Regel Wirkstoffe aus der Gruppe der Kalziumantagonisten oder der Nitropräparate. Durch die Wirkung der Präparate heilen die Fissuren oftmals ohne eine weitere Behandlung aus.

Hausmittel bei einer Analfissur

Bei einer Analfissur sollten Sie sich immer an einen Spezialisten wenden und nicht lange versuchen, die Probleme selbst durch Hausmittel zu lindern. Einige Tipps können dennoch dabei helfen, die Schmerzen zu lindern und die Heilung zu unterstützen:

  • Warm sitz baths:  The warmth of the water can relax the anal sphincter and thus prevent constipation. An anal douche or bidet can also help to relax the muscles after a bowel movement and prevent additional irritation from toilet paper.
  • Psyllium husks One teaspoon of psyllium seeds in about 200 milliliters of water binds fluid and thus ensures softer stools.
  • Anal dilator:  By regularly stretching the anal sphincter with the small plastic cone, the tension in the muscles will ease over time. Anal dilators are available in different sizes. So-called anal fissure pins are slightly smaller.


Use of anal dilators

An anal dilator is inserted into the anal canal to  stretch it and the anal sphincter . To do this, apply some ointment, such as zinc ointment, to the front part of the anal dilator or anal fissure pen. Lay on your side with your knees pulled up and carefully insert it.

Initially, you may experience pain when using it, but this should improve over time. It is best to use an anal dilator in the morning and evening and leave it in the anal canal for a few minutes each time. Regular use can speed up the healing of an anal fissure.

Surgery as a last resort

However, an anal fissure cannot always be treated with home remedies, ointments and creams alone – in some cases, surgery is necessary. This is usually the case when the sentinel fold or the fibromas are very pronounced. Surgery is also necessary if an  anal fistula  has formed.

In the case of a sentinel line or scarred tissue, the doctor will attempt to remove the affected tissue as flatly as possible (fissurectomy). While the anal sphincter was often severed in the past, this type of operation is rarely performed today. This can lead to  stool incontinence in old age  .

After an operation, it usually takes several weeks for the wound to heal. During this time, it is particularly important   to keep the stool soft by drinking enough fluids and fiber . Wound healing can be supported by ointment dressings and sitz baths.

Preventing an anal fissure

The best way to prevent anal fissures is to eat a healthy and balanced diet. Drink plenty of fluids every day: ideally between one and a half and two liters of water per day.

Also make sure that your diet contains enough fiber: choose whole grain products as well as fruit and vegetables. This will keep your stool soft and avoid straining when you go to the toilet.

Sufficient exercise is also essential to stimulate intestinal activity and thus prevent an anal fissure.

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