7 Causes Of Anal Fissures

Anal Fissure refers to a condition where there is a tear along the anal canal or the anal mucosa, which is a thin lining along the anal canal⁽²⁾. This tear in the anal canal normally occurs when an individual passes enormous amounts of hard stools. The anal tear causes the individual to experience severe pain and at times bleeding when passing bowels ⁽²⁾. Spasm of the anal sphincter also occurs due to anal fissure or tear. Anal Fissure is quite a harmless condition and affects many infants and even adults of any age can also get it^[1].

The diagnosis of an anal fissure is quite easy and can be done just by a physical examination and description of the symptoms⁽²⁾. Very rarely are additional tests or investigations are required for diagnosing anal fissures^[1].

Approximately half of the cases of anal fissures can be treated by following lifestyle and dietary modifications alone like increasing fluid and fiber intake to soften up the stools. In some cases, however, more aggressive medication intervention and even surgery is needed for treatment of anal fissure, especially if it is left untreated^[1].

Anal Fissures are subdivided into primary and secondary types. While primary form of anal fissure is benign and poses no threat, secondary form of anal fissure indicates a more serious underlying pathology requiring further investigations for a cause.

This article gives an overview of some of the potential causes of Anal Fissures^[1].

There is no specific cause which leads to the development of anal fissures according to various research studies. However, majority of the cases of anal fissures result due to low intake of fiber in the diet. A low fiber intake results in the body finding it hard to digest the food causing hard stools to form. These hard stoos when pass through the anal canal cause a tear and the resultant symptoms of anal fissure^[1].

There are; however, quite a few risk factors which increase the likelihood of an individual having anal fissures. These risk factors for or potential causes of anal fissure include:

1. Chronic Constipation Leads to Anal Fissure⁽²⁾: Constipation causes large amounts or hard stools to form, which the body finds it hard to eliminate. When these stools pass through the anal canal, they tend to tear the sensitive anal mucosa causing anal fissure^[2]
2. Anal Fissure Caused by Diarrhea⁽²⁾: Chronic diarrhea also has the potential to cause anal fissure. Repeated watery stools several times a day irritates the anal mucosa and causes anal fissure^[2].
3. Muscle Spasms Causing Anal Fissure⁽²⁾: Research suggests that people who have spasms of the anal sphincter are at an increased risk of developing anal fissure. An anal spasm occurs when the anal muscles tighten up all of a sudden. If the spasms continue even after development of anal fissure it tends to delay the healing process^[2].
4. Childbirth & Pregnancy Can Also Cause Anal Fissure⁽²⁾: This is yet another potential cause and risk factor for pregnant females to develop anal fissures. This is because during childbirth, excess pressure is put on the anal canal. This in some cases results in a tear of the anal mucosa causing anal fissure^[2].
5. Anal Fissure as a Result of Sexually Transmitted Diseases⁽²⁾: People who indulge in unprotected sex with multiple partners and end up having sexually transmitted diseases like HPV, herpes, chlamydia, and HIV have an increased likelihood of having anal fissures^[2].
6. Some Medical Conditions can also Cause Anal Fissure⁽²⁾: There are also certain medical conditions like Crohn Disease and ulcerative colitis, which also increase the likelihood of an individual having anal fissures. This is because these conditions result in ulcers to form along the anal canal, which later result in the tearing of the anal mucosa causing anal fissures^[2].
7. Anal Fissure due to Increased Sphincter Pressure: There are two sphincters that control the anus of which one is the outer sphincter and one is the inner⁽²⁾. While the outer sphincter is not under constant pressure, the inner one is always under pressure⁽²⁾. Research suggests that when the pressure gets excessive, then it may cause the sphincter to spasm causing an anal fissure^[2].

In conclusion, there is no specific cause as to why anal fissures develop. However, there are numerous risk factors which increase the likelihood of an individual developing anal fissure. These include poor intake of fiber in the diet, medical conditions like Crohn Disease, unprotected sex with multiple partners and anal sex^{[1, 2]}.

Thus it is highly advisable to refrain from activities that may put an individual at risk for anal fissures as it may lead to potential complications requiring aggressive medical management and even surgery in some cases^{[1, 2]}.

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