Anal fistulas , commonly known as anal fissures , are the area within the anal canal where glands are located that soften and lubricate stool during bowel movements. If they become blocked for any reason and become susceptible to infection, they can be extremely painful. A fistula is a normally absent connection between the tissues of a hollow organ or a channel-like space in the body. It is a tear in the anus that occurs after prolonged constipation or diarrhea. Everyone experiences difficulty defecating at some point in their lives. However, this long-term problem can lead to specific discomforts.

Anal fistulas are channels located between the intestinal tissue inside the anus and the skin outside . This infection, which occurs when the channels become blocked, can lead to an abscess formation in the area. Furthermore, existing abscesses can become chronic, posing a health risk. The anal area is a particularly risky area, becoming dirty and prone to infection.

While it occurs in both sexes, it is more common in men than in women. This increase is due to hormonal changes.

The length of the tunnels in the anal canal can range from 2 cm to 7-8 cm.

What are the causes of anal fistula (anal fissure)?

• Firstly, it occurs with the long-lasting diarrhea and constipation that are known to everyone.
• Stretch marks that occur during pregnancy or during (after) birth.
• Sexually transmitted infections.
• Anal Trauma (accident, injury, enema application, etc.)
• Previous anal surgeries.
• Consuming foods and drinks that are difficult to digest.
• Intestinal diseases

In addition to all this, anal fissures can also occur without any apparent cause. They typically manifest as difficulty defecating in most patients and are caused by stools that are too hard. Delaying the urge to go to the bathroom can cause the stool to remain in the colon and harden even more. Insufficient fluid intake can lead to hardened stools. For a variety of reasons, stools that are too hard can cause cracking of the sensitive anal skin.

What are the symptoms of anal fistula?

Patients with anal fissures often present with the same complaint. The first symptom of anal fissures is pain after bowel movements. Another symptom is bleeding from the anus. This bleeding isn't always present and is usually secondary. Patients generally describe the pain as being cut with a knife or as if a shard of glass was being pulled out. The pain typically lasts 5-10 minutes, but can also last 1-2 hours. The severity of the pain depends entirely on the individual.

If we list the symptoms;

• The patient may have difficulty sitting.
• Bleeding in the anus due to the opening of the wound.
• Redness in the anus.
• Difficulty in going to the toilet and pain during defecation.
• Sensitivity and itching of the skin around the anus.
• Sensitivity, redness and inflammation of the skin.
• The patient feels a feeling of fullness in the anus.
• A foul-smelling discharge from the anus and soiling of underwear.

When these symptoms appear, it's essential to consult a doctor for diagnosis. A doctor's examination is crucial for proper diagnosis and treatment. Patients often try to avoid the symptoms by using medications they've heard about from family and friends without consulting a doctor. However, this only wastes the patient's time. Therefore, it's recommended that patients prioritize their illness and consult a doctor as soon as possible, taking their condition into account.

How is Anal Fissule Diagnosed?

There are several stages in diagnosing anal fistula. As mentioned above, patients with one or more similar complaints first undergo an examination. The external opening outside the anus is examined. Once the external opening is identified, a rectal examination is performed, which involves palpating the bulge in the anal wall caused by the fistula. However, MRI imaging is preferred to fully visualize and identify the fistula line. Medication is not a part of the treatment. Surgery is the definitive treatment for anal fistulas. For patients over 40-50 years of age, a colonoscopy is necessary to rule out other underlying conditions.

This examination allows the doctor to determine the presence of an abscess in the area, the length of the fistula line, and its relationship to the anal muscles. This is crucial for diagnosis.

How is Anal Fistula Treated?

Treatment of anal fissures is always surgical. The surgical method is determined by the location of the anal fistula. The mapping obtained through the procedure is tailored to the surgical procedure. The goal is to soften and regularize stools based on these diagnoses. The mainstay of treatment is to stop the foul discharge and close the wound without losing the patient's bowel control. If there is an abscess or an infection, surgical intervention is definitively initiated after the abscess is drained and the infection resolves. This surgery, which can be performed under general or local anesthesia, treats anal fissures, allowing patients to return to their normal lives within 48 hours. Untreated anal fistulas can become chronic over time. Anal fistula surgery takes approximately 20-30 minutes. A 2 cm opening is made in the anus, and approximately 15 mm of the intestine causing the fissure is excised. Depending on the extent of the wound, stitches may or may not be placed. Abscesses and fistulas may develop at the wound site after surgery. The surgery may temporarily damage the muscles that help you hold in your bowels, and you may experience mild gas and stool incontinence. However, these problems typically improve and resolve over time.

What Should Be Considered After Surgery?

• First, it is normal to experience rectal bleeding after surgery. To prevent this, hot water application should be performed for 5 minutes three times a day.
• Medicines prescribed by the doctor should be used regularly and attention should be paid to the diet.
• The patient should not neglect his/her check-ups under the supervision of a doctor.
• Foods and drinks that facilitate digestion should be consumed. Care should be taken to consume high-fiber foods.
• Since water consumption is very important for health and body, the patient should not neglect water consumption during the recovery process.
• We must consume 3 litres of water a day.
• Hard toilet paper should be avoided; rather, very soft toilet paper should be used. If the toilet paper feels hard, wet wipes can be used.
• Foods that are not spicy or hot should be consumed.
• Foods with seeds should be avoided for a while. Otherwise, these foods can contaminate the wound and slow down the healing process.
• The patient should consume foods that soften the stool, such as greens, plenty of water and yoghurt.

Which Patients Should Have Anal Fistula (Anal Fissure Surgery)?

Patients who should not undergo anal fissure surgery face increased risks when they undergo the procedure. These include postoperative gas incontinence and uncontrolled bowel movements.

Situations requiring surgery are as follows:

• The patient experiences pain in the anus after using the toilet.
• The patient has rectal bleeding after using the toilet.
• If there is sensitivity in the anal skin
• If the patient is reluctant to go to the bathroom outside and is worried about what might happen when they do, anal fissure surgery is considered appropriate. The most common concern after anal fissure surgery is the recurrence process. However, the risk of recurrence after surgery is very low.

What are the Harms of Anal Fissures?

This condition negatively impacts a person's quality of life. Anal fissures, which reduce quality of life, can lead to negative consequences, such as frequent trips to the bathroom and prolonged periods spent on the toilet.

Because it causes severe pain and bleeding, it psychologically impacts a person's daily life. Patients who do not wish to undergo surgery often avoid the toilet and consume less food, leading to weight loss.

Most Frequently Asked Questions?

Does Anal Fissure Heal On Its Own?

This is absolutely not the case. While an anal fissure may seem minor, it doesn't heal on its own. As time goes on, the fissure deepens, increasing the risk of infection. If left untreated, the anal fissure can become intractable for the patient.

Does anal fissure pose a risk of cancer?

Anal fissures are unlikely to pose a cancer risk. There's no risk of the fissure becoming cancerous. This is because the relationship between anal fistulas and cancer is similar only in location.

What can be done at home for anal fissure?

First of all, increasing water consumption reduces the risk of anal fissures. Olive oil, which promotes regular digestive function, is a panacea for many ailments. Another food to consume is green leafy vegetables, which are crucial for promoting bowel movements. Don't delay bowel movements, and especially clean the anal area. Perform a warm water shower; apply warm water to the anus at least three times a day.

While not as significant as constipation , reducing your intake of certain foods can be beneficial for anal fissures. These include: red peppers, pickles, limited amounts of tea and coffee, alcohol, fast food, and spicy foods. Care should be taken to limit or eliminate consumption altogether.

The most commonly preferred method for anal fissures is the sitz bath. This method involves first filling a basin or tub with hot water. The patient remains in the hot water for 10-15 minutes, which relaxes the muscles in the anal area. It is crucial for the patient to take a hot bath daily for their health.