Talk:Anal fissure

facts needing confirmation

newly added 9/29/08 - Need a peer reviewed medical journal citation showing that a "common" cause of anal fissure is "excessive anal intercourse".

There are so many dubious statements in this article it's got me really questioning much of it. I'm not an expert but I'm pretty sure that at least half of the following is wrong or misleading:

Anal fissure .... is usually shallow (less than a quarter of inch or 0.64 cm deep). (ES: i'd have thought less than this but not sure)

Causes: Various causes of this fissure include:... ... *severe and chronic diarrhea (ES: really??)

• Crohn's disease (ES: chron's causes fistulas which are quite diferent from fissurs... so dunno about fissure)
• spastic tight sphincter muscles

Anal fissure is common in women after childbirth and in infants.... (ES: i don't think so. after childbirth women may suffer lacerations that may involve the anus but these aren fissures!)

Prevention: In infants under one year old, frequent diaper change can prevent anal fissure. For adults, the following can help prevent fissure: (ES: that may prevent nappy rash!!! a very different thing) ... *Treating diarrhea promptly ... (ES: this is very dubious)

• Using a moist wipe instead of perfumed and harsh toilet paper. (ES: this may help but not really sure)
• Keeping the anus dry and hygienic. (ES: this may help but not really sure)

Treatment: Anal fissures in infants usually self-heal without anything more than frequently changing diapers. (ES: this whole anal fissure in baby thing seems very odd... and again the management would be treating the constibpation and analgesia... not diaper changes)

Deep fissures, ... surgery ... (ES: I think this whole section sounds out of date and needs verification)

Erich 06:32, 11 Jan 2005 (UTC)

References

On diarrhea as a possible cause of anal fissure:

"Another cause and a risk factor that can not be ignored is that, Anal Fissure can also be caused by having unusually tight anal sphincter muscle (increased tension in the anal canal makes it more susceptible to tearing)."   — Preceding unsigned comment added by Sfahadhussain230785 (talk • contribs) 11:58, 9 March 2020 (UTC) 

"In adults, fissures may be caused by constipation, the passing of large,
hard stools, or by prolonged diarrhea." MedlinePlus - Anal Fissure

"Other causes of a fissure include diarrhea and inflammation of the 
anorectal area." ACRS - Anal Fissure

On anal fissure, childbirth & Crohn's disease:

"Anal fissures are also common in women after childbirth and 
people with Crohn's disease." MedlinePlus - Anal Fissure

"Fissures can also be caused by anal trauma, laxative abuse, 
childbirth trauma, or laceration by a foreign object." McKinley Health Center - Anal Fissure

On prevention:

"To prevent anal fissures in infants, be sure to change diapers
frequently." MedlinePlus - Anal Fissure

To prevent fissures at any age:
   * Keep the anal area dry
   * Wipe with soft materials or a moistened cloth or cotton pad
   * Promptly treat any constipation or diarrhea
   * Avoid irritating the rectum
MedlinePlus - Anal Fissure

On anal fissure in infants:

"Anal fissures are extremely common in young infants but may occur 
at any age. Studies suggest 80% of infants will have had an anal 
fissure by the end of the first year. Most fissures heal on their 
own and do not require treatment, aside from good diaper hygiene. 
However, some fissures may require medical treatment."
MedlinePlus - Anal Fissure

Hfwd 22:26, 11 Jan 2005 (UTC)

geez it still seems odd to me... but there you go... sorry to have troubled you! Erich 07:21, 12 Jan 2005 (UTC)

There is sometimes confusion between what is a hemorrhoid and what is an anal fissure. "A person not-trained in hemorrhoids treatment may confuse hemorrhoids with anal fissure, or even warts, and even colon cancer. Thus, when you want to get a proper medical attention, you should consult a doctor, since a personal diagnosis can be both difficult and dangerous." http://hemorrhoidsandtreatment.theazonway.com/diagnosis-of-hemorrhoids/ — Preceding unsigned comment added by 189.136.121.85 (talk) 20:37, 8 April 2012 (UTC)

Diarrhea

It doesn't have to be a series of diarrhea events that cause the fissure. One, large, fast moving bowel movement of diarrhea is enough to cause a fissure. Obviously you've never had Mexican food before.

LMFAO 216.165.151.101 (talk) 21:10, 29 September 2008 (UTC)

Medical mx

doi:10.1111/j.1572-0241.2007.01203.x reviews non-surgical approaches. JFW | T@lk 15:23, 26 April 2007 (UTC)

All looking forward to reading article having read the intro abstract - except it is by subscription only - shame, was wondering what is best GTN oint or the more recently introduced diltiazem oint (and again both of these vs botox injection - ouch!) :-) David Ruben ^Talk 16:03, 26 April 2007 (UTC)

With botox, no more anal wink. JFW | T@lk 04:21, 27 April 2007 (UTC)

What, no picture?

C'mon. --Adam Corolla Actually, seriously. What does one look like? I was wondering myself to see if what I have is fissures or just Hemroids. Could we have at least one? ~m0u5y —Preceding unsigned comment added by 75.15.223.94 (talk) 23:15, 21 August 2008 (UTC)

Go see a doctor.--131.111.236.123 (talk) 18:01, 23 October 2008 (UTC)

Very much THIS. If you do manage to stare at your own anus through mirrors, or trickery, I'd recommend against making your own diagnosis, god forbid treatment.--Evilbred (talk) 13:10, 23 March 2010 (UTC)

Along with the masturbation article, this is just one of those Wikipedia articles that does not need a picture - animated, photographed or otherwise. MisplacedFate1313 (talk) 06:18, 5 March 2009 (UTC)

Well, it has a picture now, and masturbation has several :O Zoombus (talk) 01:50, 21 December 2010 (UTC)

I think that having a pic here does not help at all. If one feels or suspects s/he has an anal fissure s/he cannot look at the pic and compare it with his/hers. It is an unnice view and not a real contribution. I support firmly and request kindly its removal. Thanks. --E4024 (talk) 15:50, 21 January 2013 (UTC)

WP:NOTHOWTO. Wikipedia is not here to help those who "feel or suspect have an anal fissure". Charles35 (talk) 16:55, 21 January 2013 (UTC)

Charles35 I am sure you understood me very well. Thank you. --E4024 (talk) 17:09, 21 January 2013 (UTC)

I'm sorry if I am mistaken, but do I detect sarcasm? Charles35 (talk) 17:12, 21 January 2013 (UTC)

Really

"Stop excessive anal fisting is a must"...also any objects inserted must be attended too. —Preceding unsigned comment added by 209.86.226.13 (talk) 03:38, 6 February 2009 (UTC)

Agreed, who's to say how much is truly excessive?--Evilbred (talk) 15:45, 13 September 2011 (UTC)

Cause

Fissures have been caused by taking iron pills which make the stool very hard and large.

I dont think u should've said "stool"...  — Preceding unsigned comment added by 173.168.120.77 (talk) 05:53, 6 July 2011 (UTC) 

Prevention

As per WP:MEDICAL, should this section be here at all? --King Öomie 21:14, 28 October 2009 (UTC)

I think it's okay. The medical disclaimer just says, don't take anything on Wiki as actual advice. It's okay to have information on prevention techniques, as long as it's not written like, "You should do this to prevent anal fissures" 71.113.32.33 (talk) 03:44, 21 July 2010 (UTC)

Poor diagnosis by general practitioners?

Many years ago I developed an anal fissure. The diagnosis from a general practitioner: hemorrhoids (I also had to a small extend hemorrhoids but in retrospect that was not the cause of the bleeding and the itching I had). Recently it became acute. Diagnosis from another general practitioner in another country: internal hemorrhoids. Given the fact that I had severe pain for 12 hours after defaecation during 2 weeks I demanded referral to a specialist (not easy in my country: the Netherlands). The general practioner referred me for a rubber band ligation. The surgeon, after hearing how much pain I had (the nurses were worried) suspected the acute anal fissure. So he checked it out by letting me sit on my knees and elbows and confirmed this. He explained that general practitioners often misdiagnose this as hemarrhoids, partially because the patient has to sit in this not so pretty way in order to observe the fissure. It is NOT my intention to share my personal story, I only put it down here with the intention that if other people have the same experience we should add a section to the article about the unability of many general practitioners to diagnose this problem.

82.170.40.166 (talk) 00:47, 13 November 2010 (UTC)

Your personal experience combined with the personal experience of others is not a reliable source for medical content on wikipedia...however I'm sure a suitable source could be found to support that many common colorectal conditions present with similar symptoms and are therefore sometimes hard to differentiate from one another. Lesion (talk) 13:28, 2 April 2013 (UTC)

Recent review articles

[1] Doc James (talk · contribs · email) 21:14, 5 April 2011 (UTC)

Incorrect reference about anal dilation removed.

I have removed the reference in support of the clam that "Anal dilation... has fallen out of favour in recent years, primarily due to the perceived unacceptably high incidence of fecal incontinence."

The source does state that "undue anal stretching or other damage to the sphincter can have devastating effects on fecal con- trol." However, this statement is made in the context of spreading the anus in order to surgically remove fissures and warts. It does not apply to anal dilation as a treatment method.

Source removed: Kotlarewsky, M. (2001). "Anal Intraepithelial Dysplasia and Squamous Carcinoma in Immunosuppressed Patients" (PDF). Canadian Journal of Surgery (Journal Canadien de Chirurgie). 44 (6): 450–454. PMID 11764880. Retrieved 2009-05-12. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Anal Sex: causing fissures a myth?

I once read a study claiming people who partake in anal sex don't have a remarkably higher incidence of fissures than those who don't. I wish I can say I was able to find the source of this study but I cant. It said it's often just confusion over the causation of the fissure, which one would intuitively think anal sex is but usually isn't, as most people who have both fissures and anal sex also have digestive troubles which would lead to a fissure. If anybody can find a source regarding this, please do add it and change the article as needed. — Preceding unsigned comment added by Lerikson (talk • contribs) 07:40, 9 February 2012 (UTC)

I can't find any reliable secondary source that mentions anal sex as a cause of anal fissuring. 2 major textbooks specifically did not mention it: <ref>{{cite book|last=al.]|first=senior editors, Bruce G. Wolff ... [et|title=The ASCRS textbook of colon and rectal surgery|year=2007|publisher=Springer|location=New York|isbn=0-387-24846-3}}</ref> ; <ref>{{cite book|last=al.]|first=edited by Tadataka Yamada ; associate editors, David H. Alpers ... [et|title=Textbook of gastroenterology|year=2009|publisher=Blackwell Pub.|location=Chichester, West Sussex|isbn=978-1-4051-6911-0|edition=5th ed.}}</ref> . Also ran a quick pubmed search: there is this case study pmid=18074923 and this primary source pmid=20184055...but no review that I found. Suggest if no reliable secondary source can be found to support anal sex as a cause, this be removed from the article. Lesion (talk) 01:00, 28 February 2013 (UTC)

Just another case of "anal sex causes (name of colorectal pathology article).{{medical citation needed}}" ... Lesion (talk) 01:08, 28 February 2013 (UTC)

Lesion, I guess it depends on how one defines anal fissure. The lead of the Wikipedia Anal fissure article currently states, "An anal fissure or rectal fissure is a break or tear in the skin of the anal canal." And there are various WP:MEDRS (medical)-compliant sources, such as this WebMD source and this scholarly book source (page 455) that I used for the Anal sex article, stating that anal sex can result in tears in the anus or rectum; in fact, that scholarly book source notes that tiny tears and bleeding in the rectum (though the bleeding is usually not visible) almost always result from anal sex "because the rectum does not stretch easily, the mucous membrane is quite thin, and small blood vessels lie directly beneath the membrane." Again, the lead of the Anal fissure article states "anal canal," but it also states "rectal fissure," and the current picture showing an anal fissure looks like it's right on the anus. And there are WP:Reliable sources that define "anus" to include "anal canal." Flyer22 (talk) 11:56, 28 May 2014 (UTC)

And, of course, anal fisting, which is a form of anal sex, can (is very likely to) cause severe damage to the anus and rectum. Anal dilation is related to that, though not exactly the same thing, and here TJRC added some WP:Reliable sources for the anal dilation aspect. Flyer22 (talk) 05:15, 19 August 2014 (UTC)

Caffeine is a constipating agent?

Is this true, I thought the opposite... 23_2{(SBST:SU:m.}} (talk)

Yeah that's weird. I removed it. I checked the source...doesn't even mention caffeine... Charles35 (talk) 03:16, 28 February 2013 (UTC)

Reference #27 = "malicious website" per my Malwarebytes

"27 Sohn, M.; Weinstein, M. A. "Anal Dilatation for Anal Fissures" (PDF). Retrieved 2009-07-15.[dead link][dead link]Template:Malicious website"

1. I added { {Malicious website|date = October 2014} } which came out as you see it in the Reference list. Feel free to repair the tag.
2. I couldn't find an article by this title on PubMed.

Would this article be helpful to the point the author was trying to make? I don't have access to the entire article:

• "Precise Anorectal Sphincter Dilation - Its Role in the Therapy of Anal Fissures"

SOHN, N; EISENBERG, MM; WEINSTEIN, MA; LUGO, RN; ADER, J Diseases of the Colon & Rectum Volume: 35; Issue: 4; Pages: 322-327; Published: APR 1992
[Abstract only]
http://cel.webofknowledge.com/InboundService.do?product=CEL&SID=3CLnimy2zxrWGIZQGU2&UT=A1992HN08700005&SrcApp=literatum&action=retrieve&Init=Yes&Func=Frame&SrcAuth=atyponcel&customersID=atyponcel&IsProductCode=Yes&mode=FullRecord
http://www.ncbi.nlm.nih.gov/pubmed/1582352?dopt=Abstract

Several letters to the editor endorsing, then disputing, "controlled/precise anal dilation". Both sides refer to the above Sohn et al article:
Correspondence

• "Treatment of Chronic Anal Fissure"

New England Journal of Medicine; June 4, 1998
http://www.nejm.org/doi/full/10.1056/NEJM199806043382314#t=article

Apparently, this is a reply to an article:
Diseases of the Colon & Rectum. 2008 Jul;51(7):1168; author reply 1169. Epub 2008 Apr 18.

• "Subcutaneous fissurotomy included a disguised and unappreciated anal spincter dilatation."

Sohn N, Weinstein MA.
Comment on: "Subcutaneous fissurotomy: a novel procedure for chronic fissure-in-ano. a review of 109 cases." [Diseases of the Colon & Rectum. 2007]
[Unable to connect to it, though - does anyone have access?]:
http://www.ncbi.nlm.nih.gov/pubmed/18421502

Review article that could well mention "controlled/precise anal dilation" - does anyone have access?:
Techniques in Coloproctology
September 2007, Volume 11, Issue 3, pp 209-223
Date: 03 Aug 2007

• "A review of chronic anal fissure management"

E. E. Collins, J. N. Lund
[Abstract & also click "Look Inside" for a two-page peek at the article]:
http://link.springer.com/article/10.1007%2Fs10151-007-0355-9
[Abstract only]:
http://www.ncbi.nlm.nih.gov/pubmed/17676270

Thank you, Wordreader (talk) 04:37, 28 October 2014 (UTC)

Pain

I have fissures secondary to parakeratosis caused by pelvic radiation injuries and therefore have experience with their associated pain.

1. I've read in an anal fissure user forum where some sufferers report being told by their MDs that it was impossible for physical movements of the body to add to the pain of fissures. If some doctors have said this, I find that belief to be short-sighted and illogical. Surely this is not a universal belief held by the colorectal medical world? Anything that causes traction to the site would, of course, cause increased pain, including sitting, standing, walking, bending, crouching, and lifting.

2. As distracting as fissure pain is, I generally ride it out if I have to drive somewhere. A few times a week, however, it radiates right up into the center of my core like raw nerves, causing my hands to tremble and causing pursed-lip breathing. Then, I cannot live with it, but must take pain medication. I am curious about the mechanism that causes the pain to radiate and the pathway it takes. Why is this pathway sometimes turned on and sometimes not? I'm very curious about this.

Thank you, Wordreader (talk) 03:47, 1 December 2014 (UTC)

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