Anal fissures
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A fairly common, painful condition in which a small portion of the anal canal lining is torn or cut. The anal canal is the last part of the rectum which ends at the anus. Stool passes through the anal canal and anus during a bowel movement. An anal fissure can be caused by constipation or a forceful bowel movement, although a tight anus also may be a contributing factor. Once the skin is torn, each subsequent bowel movement can be painful, Often there is bleeding associated with a painful bowel movement. The amount of bleeding is usually small and may be noticed in the toilet bowl or on the toilet paper as bright red in color. The symptoms of an anal fissure are commonly mistaken for hemorrhoids, but hemorrhoids normally do not cause pain during bowel movements.

To diagnosis an anal fissure is done by examination of the anus and anal canal. The tear usually is easy to see, although occasionally a small viewing instrument, called an proctoscope, sometimes will be used in the evaluation.

Initial treatment of an anal fissure generally is conservative and consists of stool softeners, high fiber diet with fiber supplements, and sitz baths (i.e., sitting in a tub of warm water while warm water sprays against the anus). Suppositories, Over-the-counter creams or ointments that contain hydrocortisone can be applied to the anal area to help reduce inflammation. Enemas can be used to help soften and move feces.  But care must be taken when inserting the nozzle or rectal tube.   Make sure you lubricate the nozzle or tube and the anus generously.  Keeping the anal area clean is imperative.

About 50-75% of anal fissures treated in this fashion will usually heal in a couple of weeks. If the fissure does not heal, you need to see your health care provider


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Warning: Do not use enemas or laxatives if abdominal pain, nausea, or vomiting are present unless directed by your health care provider.
Rectal bleeding or failure to have a bowel movement after use of a laxative or enema may indicate a serious condition.
Discontinue use and consult your health care provider.

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