Are stress, depression, anxiety and fatigue related to anal fissures?

Anal fissures are cracks or tears in the lining of the anal canal and anus. Young and middle-aged adults usually experience this anal condition. It may also occur in infants and the elderly.

These fissures can be painful and irritating, especially during or after a bowel movement. Other symptoms include bleeding, itching, and painful urination.

The primary risk factor of anal fissures is trauma or injury. Trauma to the anal canal or anus may result from vaginal child delivery, frequent passage of large stools, explosive diarrhea, anal intercourse, or insertion of any foreign object into the anus.

Less common causes of fissures include anal tumors, infections, and some colorectal diseases.

Some people ask if stress, depression, anxiety, and fatigue are related to anal fissures. Well, these factors may be interrelated. Besides, we only have one brain that controls our emotions and our digestion.

To make it clear though, these emotional problems do not cause anal fissures.

Stress and anxiety can lead to the development of Irritable Bowel Syndrome and Inflammatory Bowel Disease. These two conditions may cause the anal tears.

Stress can disrupt GIT functions and symptoms like constipation, diarrhea, and muscle spasms may be manifested by the patient.

Depression and constipation can also coexist if a person has low levels of serotonin, the neurotransmitter responsible for mood balance. Prolonged constipation increases the risk of a person to develop fissures.

There is also a link between fatigue and constipation. Patients who are severely dehydrated can experience both fatigue and constipation.

These emotional problems may also occur as complications of fissures. This condition can affect the quality of life of a patient, especially if it is chronic and recurring.

Anal fissures may be acute or chronic. Chronic fissures usually last for more than six weeks.

Treatment varies. Acute fissures usually heal from a combination of medical treatments. Whereas, treatment of chronic fissures usually involves surgery.

Medical treatments include the following:

• Sitz bath. The goal of this treatment is to promote blood circulation and healing of the affected area. Patient soaks his anus in a sitz bath or a basin filled with warm water for ten to fifteen minutes for two to three times a day.
• Fiber therapy. This aims at preventing constipation. Fiber-rich foods like wheat bran, whole grass, and leafy green vegetables help soften stools and speed up bowl movement.
• Topical medications (Nifedipine, Diltiazem, Nitroglycerin, Anesthetics, Steroid). These medications are applied directly over affected area to relieve pain, itching, inflammation, and promote the healing of the fissures.
• Stool softeners. Stool softeners are given to patients to prevent ease bowel movement and prevent constipation.
• Botulinum Toxin injection. A small dose of BOTOX is injected over the affected site to paralyze the muscles and promote healing.

Lateral internal sphincterotomy is the most popular form of surgery used to treat anal fissure. In this procedure, a part of the internal anal sphincter is removed to reduce muscle spasm.

In children, fissurectomy may be done to surgically remove the fissure.

Treatment results vary per patient. Some patient with chronic fissures receive help from BOTOX injection, while others would need surgery.