Renal fissure

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Overview

An anal fissure is a superficial tear in the skin distal to the dentate line and is a cause of frequent emergency department visits. In most cases, anal fissures are a result of hard stools or constipation, or injury. Anal fissures are common in both adults and children, and those with a history of constipation tend to have more frequent episodes of this condition. Anal fissures can be acute (lasting less than six weeks) or chronic (more than six weeks). The majority of anal fissures are considered primary and typically occur at the posterior midline. A small percentage of these may occur at the anterior midline. Other locations (atypical/secondary fissures) can be caused by other underlying conditions that require further workup. The diagnosis of an anal fissure is primarily clinical. Several treatment options exist, including medical management and surgical options.Causes of anal fissures commonly include constipation, chronic diarrhea, sexually transmitted diseases, tuberculosis, inflammatory bowel disease, HIV, anal cancer, childbearing, prior anal surgery, and anal sexual intercourse. The majority of acute anal fissures is thought to be due to the passage of hard stools, sexually transmitted infection (STI), or anal injury due to penetration. A chronic anal fissure typically is a recurrence of an acute anal fissure. It is thought to be also caused by the passage of hard stools against an elevated anal sphincter tone pressure, with symptoms lasting greater than six weeks. Underlying conditions such as inflammatory bowel disease, tuberculosis, HIV, anal cancer, and prior anal surgery are predisposing factors to both acute and chronic atypical anal fissures. Approximately 40% of patients who present with acute anal fissures progress to chronic anal fissures.

Symptoms

Signs and symptoms of an anal fissure include:


Pain during, and even hours after, a bowel movement

Constipation

Blood on the outside surface of the stool

Blood on toilet tissue or wipes

A visible crack or tear in the anus or anal canal

Burning and itching that may be painful

Discomfort when urinating, frequent urination, or inability to urinate

Foul-smelling discharge

Causes

Anal fissures can be caused by trauma to the anus and anal canal. The trauma can be caused by one or more of the following:

Chronic (long-term) constipation

Straining to have a bowel movement, especially if the stool is large, hard and/or dry

Prolonged diarrhea

Anal sex, anal stretching

Insertion of foreign objects into the anus

Causes other than trauma include:

Longstanding poor bowel habits

Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)

Scarring in the anorectal area

An underlying medical problem, such as Crohn's disease and ulcerative colitis (types of inflammatory bowel disease); anal cancer; leukemia; infectious diseases (such as tuberculosis); and sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)

Decreased blood flow to the anorectal area

Anal fissures are also common in young infants and in women after childbirth.

Risk factors

Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.

Childbirth. Anal fissures are more common in women after they give birth.

Crohn's disease. ...

Anal intercourse.

Age.

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Complications

Pain and discomfort.

Reduced quality of life.

Difficulty with bowel movements. Many people even avoid going to the bathroom because of the pain and discomfort it causes.

Possible recurrence even after treatment.

Clotting.

Uncontrolled bowel movements and gas.

Prevention

You can’t always prevent anal fissures, but you can reduce your risk of getting one by taking the following preventive measures:

keeping the anal area dry

cleansing the anal area gently with mild soap and warm water

drinking plenty of fluids, eating fibrous foods, and exercising regularly to avoid constipation

treating diarrhea immediately

changing infants’ diapers frequently if they have the condition