An anal fissure is experienced by many that suffer a linear tear of the anoderm. These are most closely associated with the passing of hard stools or anal trauma, listing them among the most common anorectal disorders among the pediatric sector. Adults may also experience similar symptoms, leading to fissures being defined as acute if they are present for less than 6 weeks and considered chronic for those that experience them for more than 6 weeks. Here is a look at the difference between a fissure and fistula as highlighted below.
Anal Fissure
This is a thin tear extending from the muscles controlling the anus on up into the anal canal. They usually develop whenever the anal tissue suffers damage from a hard bowel movement or whenever there is higher than usual tension within the anal sphincters.
Common Causes of Anal Fissures:
1. Constipation & Straining During a Bowel Movement.
2. Passing Hard or Large Stools.
3. Childbirth.
4. Chronic Diarrhea.
5. Anorectal area inflammation, caused by either Crohn’s disease or some other inflammatory bowel disease.
Less Common Causes:
1. Tuberculosis
2. Anal Cancer
3. Syphilis
4. HIV
5. Herpes
Complications
A. Recurrence: After experiencing your first anal fissure, you’re more prone to having them again.
B. Healing Failure: Any anal fissure that doesn’t heal within 6 weeks is viewed as being chronic and call for more treatment.
C. Tears That Extend to Surrounding Muscles: Anal fissures can extend into that ring of muscle used for holding your anus closed. This is called the ‘internal anal sphincter’. Unhealed fissures may trigger cycles of discomfort and require medications or even surgery to lower the pain and repair/remove any fissures.
Tests & Diagnosis
The location of a fissure is an indication of what the cause may be. Fissure occurring on the side rather than on the back or on the front of the anal opening, might be a sign of some other disorder, like Crohn’s disease. If this is suspected your physician might recommend further tests. Here are 2 ways you can be tested:
1. Flexible Signoidoscopy: A thin and flexible tube equipped with a small video camera is inserted in the bottom area of the colon. This test is usually done on people under age 50 who carry no risk factors regarding colon cancer or intestinal diseases.
2. Colonoscopy: A flexible tube will be inserted into the rectum in order to inspect the whole colon area. This test is usually done on those over age 50 or those who do have risk factors regarding colon cancer, or other signs, conditions, or symptoms like diarrhea or abdominal pain.
Anal Fistula
This is a tube-like tract or passage that goes from the anal canal to a small hole in the skin close to the anus. This type of thing can occur following rectal surgery or an abscess in that area, or from complications of bowel disease.
Anal fistulas are caused by infection within the anal gland that spreads itself to the skin. It usually requires surgery for treatment.
Tests & Diagnosis
In order to properly treat anal fistula, its complete path must be known. Finding a fistula in the internal opening of the anus is more complicated than finding one on the external side. Here are some tests commonly used for diagnosing fistulas:
1. Fistulography: This is merely an X-ray image taken once the fistula has been injected with a contrast solution.
2. Endoscopic Ultrasound: This is where high-frequency sound waves are used for producing detailed images of sphincter muscles along with various other structures found on the pelvic floor.
3. Magnetic Resonance Imaging: This is a test used when a fistula is very difficult to locate.
Additional Options
A. Fistula Probe:This is an instrument specifically designed for insertion through a fistula.
B. Flexible Sigmoidoscopy: This procedure helps rule out all other disorders like Crohn’s disease or ulcerative colitis.
C. Anocsope: This is a small endoscope for viewing the anal canal.