Often characterized by anal pain and bleeding, fissures cause severe discomfort. While they’re more prevalent in infants, they also affect adults. According to statistics, the United States reports more than 200,000 new anal fissure cases every year.

Unfortunately, some anal and colorectal cancer manifest symptoms similar to fissures, which leaves many patients wondering whether their condition is a fissure or cancer. Especially, this occurs in cases of chronic fissure or due to recurrences. Usually, once a person has a fissure, there’s always a probability of a recurrence.

Nonetheless, a fissure is a condition on its own, and its presence does not necessarily indicate the presence of cancer. In this article, we take a look into fissures and anal and colorectal cancers to help you understand their causes, symptoms, risk factors, treatment, and whether they’re preventable. 

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The Difference Between Fissure, Anal, and Colorectal Cancer

An anal fissure is a tear in the lining of the anal canal, mostly caused by passing hard or large stools. The anal canal is a tube at the end of the rectum usually surrounded by muscles. The fissure could form a lump or a skin tag, which is often confused with hemorrhoids (also known as piles, hemorrhoids are swollen veins that form either inside the rectum or outside the anus). 

Anal cancer is a type of cancer that occurs in the anal canal due to the abnormal growth of cells. According to the American Cancer Society, the exact cause of anal cancer is unknown, but most incidences are linked to HPV (human papillomavirus). Like anal fissures, anal cancer may cause anal pain and bleeding. 

Colorectal cancer, known as colon cancer or rectal cancer, depending on where it starts, develops from a growth (polyp) inside the lining of the colon or rectum. The polyps form when the cells lining the colon or rectum grow out of control. However, having polyps does not necessarily mean one has cancer since some are non-cancerous

Usually, fissures are non-cancerous. As much as they may manifest similar symptoms to anal or colorectal cancer, such as bleeding during bowel movements, they don’t cause cancer. However, having colorectal or anal cancer could trigger the formation of a fissure.  

Causes of Anal Fissure

Anal fissure result from trauma or overstretching of the anal lining, leading to a tear. Common causes include;

  • Passing hard stools
  • Chronic diarrhea
  • Passing large stools
  • Constipation
  • Straining during bowel movements

Risk Factors of Anal Fissure

In addition to the above causes, the following factors could also increase the risk of anal fissures;

  • Vaginal childbirth
  • Anal intercourse
  • Eating a low-fiber diet
  • Crohn’s disease
  • Anal cancer
  • Colorectal cancer

Risk Factors of Anal Cancer

On the other hand, anal cancer has the following risk factors.

  • HPV infection
  • Weakened immunity
  • Smoking 
  • Anal intercourse
  • History of cervical or vaginal cancer

Risk Factors of Colorectal Cancer

The exact cause of colorectal cancer is unknown. However, the following factors increase its prevalence.

  • Aging
  • Smoking
  • Poor diet (low in fruits and vegetables)
  • Alcohol consumption
  • Overweight or obesity
  • Lack of physical activity
  • Inflammatory bowel disease (Ulcerative colitis and Crohn’s disease)
  • Family history of colorectal cancer

Symptoms of Anal Fissure

Symptoms of anal fissure flare-up, especially during and after a bowel movement. As a result, patients try to avoid having bowel movements, leading to chronic anal fissure and further complications such as constipation. Common symptoms include;

  • Blood in stool or toilet paper 
  • Stinging pain during bowel movement
  • A lump or skin tag on the skin surrounding the tear
  • Pain after a bowel movement (lasting for several hours)
  • Visible tear in the skin around the anal opening

Symptoms of Anal Cancer

Sometimes anal cancer may fail to manifest any symptom. But some common anal cancer symptoms may include;

  • A lump at the anal opening
  • Rectal bleeding
  • Anal pain during bowel movement
  • Rectum and anal itching
  • Changes in bowel movements
  • Stool incontinence
  • Abnormal anal discharges

Symptoms of Colorectal Cancer

Similarly, colorectal cancer symptoms do not manifest immediately. However, when they start showing, you may experience the following;

  • Rectal bleeding 
  • Blood in stool
  • Weakness and fatigue
  • Unintended weight loss
  • Cramping or abdominal pain
  • Change in the bowel habit and movements 

When Should You See a Doctor?

You should see a doctor if;

  • You see blood on your stool or the toilet paper after a bowel movement, or
  • Experience pain during bowel movement 

After examining you, the doctor should be able to determine whether you have a fissure or other anorectal condition (fistula, hemorrhoid, etc.) or recommend further tests to rule out the possibility of either anal or colorectal cancer. 

Diagnosis of Anal Fissure

The doctor makes a diagnosis based on your symptoms, medical history, and rectal exam. In case you have a fissure, an inspection of the anal region should reveal the tear. Usually, the fissure occurs on the back or the front of the anal opening. If it appears on the side, it could indicate another underlying condition, calling for further exams. These may include;

  • Anoscopy – The doctor inserts a tubular device (anoscope) through the anal opening to view the anus and the rectum.
  • Colonoscopy – The doctor inserts a thin tubular device through the anus to view the inside of the colon.
  • Flexible sigmoidoscopy – The doctor inserts a flexible tubular device into the rectum to view the lower part of the large intestine

Diagnosis of Anal Cancer

In the same way, the doctor may diagnose anal cancer based on your symptoms, medical history, and family history. Some of the possible exams may include anoscopy, colonoscopy, digital rectal examination, anal lining swabs, biopsy, or endoanal.

  • Digital rental examination – The doctor inserts their finger into the anus to check for lesions or lumps
  • Biopsy – The doctor collects a sample of tissue for examination in the lab
  • Anal lining swabs – The doctor performs a swab test to detect unusual formations
  • Endoanal ultrasound – The doctor evaluates the sphincter structure and the anal muscle structure using high-frequency sound waves

Treatment of Fissure

If the diagnosis is positive, the doctor will recommend several treatments as follows;

Medication

  • Taking stool softeners or laxatives
  • Application of a topical anesthetic around the anus to relieve pain
  • Topical application of medication around the anal canal to relax the muscles

Lifestyle Changes and Home Remedies

  • Taking a higher fiber diet or supplements, 
  • Drinking plenty of water to soften the stool
  • Taking warm 10 to 20 minutes baths (sitz bath) a few times per day

Surgical Treatment

Surgery is rarely used in fissure treatment unless for chronic fissure, in which case, it helps the sphincter muscles relax. The two surgery options include;

  • Botulinum toxin (Botox) treatment – An injection administered to the anal sphincter muscle 
  • Lateral internal sphincterotomy – An operation on the internal sphincter muscle

Treatment of Anal Cancer

Upon a positive diagnosis, the doctor may recommend various types of treatment depending on the extent or location of cancer. These may include;

  • Surgery – Abdominoperineal resection involves removing the cancerous tissue in the anal area
  • Radiation therapy – The cancer cells are killed using high-energy x-rays or radioactive material
  • Chemotherapy – Drugs are administered to the patient to kill the cancer cells 

Treatment of Colorectal Cancer

Is colon cancer treatable? Colorectal cancer can be treated using various options. Examples of treatments include colorectal surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, etc.

Surgery includes laparoscopic, colostomy, and cryoablation, while radiation therapy may include external-beam, stereotactic, and interoperative. The use of medication therapy (chemotherapy, immunotherapy, and targeted therapy) is also a common cancer treatment

Prevention of Anal Fissure

You can prevent anal fissures through lifestyle changes and good bowel habits, including;

  • Eating a high-fiber diet and taking plenty of water to avoid strain during bowel movements
  • Regular exercise 

Prevention of Anal Cancer

Since the exact cause of anal cancer is unknown, it might not be possible to prevent it entirely. However, eliminating some of the risk factors can help lower its prevalence, such as;

  • Taking HPV vaccines to prevent infection
  • Quitting smoking
  • Practicing safe intercourse

Prevention of Colorectal Cancer

On the other hand, you may not be able to prevent colorectal cancer. But you can reduce the risk factors in the following ways;

  • Regular colorectal cancer screening 
  • Maintaining a healthy body weight
  • Exercising regularly
  • Eating a healthy diet
  • Avoiding alcohol consumption 
  • Quitting smoking

Get a Diagnosis at Immunity Therapy Center

Fissures are non-cancerous, and most can be diagnosed with a simple examination of the anal area, followed by treatment. However, since they may be caused by an underlying condition sometimes, getting a thorough diagnosis is recommended. Usually, the doctor should be able to determine the proper diagnosis based on your symptoms, medical history, and family history. While most fissures can be treated without surgery, chronic fissures may require surgery to minimize recurrence and alleviate discomfort. 

If you’re struggling with fissures or are afraid your symptoms could be due to a serious underlying condition such as anal or colorectal cancer, visit us at Immunity Therapy Center. Should the diagnosis be positive, our cancer treatment program involves stimulating the immune system to destroy the cancer cells. We also use non-invasive therapies designed to aid your healing by taking advantage of the cancer cells’ weakness. 

Contact us today for an appropriate diagnosis and treatment. 

 

Written By: Dr. Pablo Orozco

Dr. Pablo Orozco is a Board Certified Medical Doctor from Universidad Autónoma de Baja California.

Dr. Orozco has been a treating physician at the Immunity Therapy Center for more than 3 years providing daily on site patient care. He works with patients on a daily basis and guides them through the treatment process. Dr. Orozco’s passion for Alternative Cancer Treatments along with his commitment to patient care is key to insure that our patients have the best experience and results possible.

Resources:

  1. Stewart David. “Anal fissure: Clinical manifestations, diagnosis, prevention.” UpToDate, May. 2022, https://www.uptodate.com/contents/anal-fissure-clinical-manifestations-diagnosis-prevention 
  2. American Cancer Society Team. “What Causes Anal Cancer?” American Cancer Society, Sep. 2020, https://www.cancer.org/cancer/anal-cancer/causes-risks-prevention/what-causes.html
  3. Bautista Dr. “Types of Colon Polyps.” Immunity Therapy Center, Dec. 2019, https://www.immunitytherapycenter.com/blog/types-of-colon-polyps/
  4. American Cancer Society Team. “Colorectal Cancer Signs and Symptoms.” American Cancer Society, Jun. 2020, https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/signs-and-symptoms.html
  5. Memon Nazneen. “Is a Fissure a Lump? Anal Cancer Symptoms & Diagnosis.” MedicineNet, Jun. 2021, https://www.medicinenet.com/is_a_fissure_a_lump/article.htm#how_is_anal_cancer_diagnosed
  6. Memorial Sloan Kettering Cancer Center Team. “About Anal Fissure.” Memorial Sloan Kettering Cancer Center, Nov. 2020, https://www.mskcc.org/cancer-care/patient-education/about-anal-fissures
  7. Bautista Dr. “Anal Cancer.” Immunity Therapy Center, Nov. 2019, https://www.immunitytherapycenter.com/diseases-we-treat/cancer-treatment/anal-cancer/
  8. Bautista Dr. “How Is Cryoablation Performed?” Immunity Therapy Center, Feb. 2021, https://www.immunitytherapycenter.com/blog/how-is-cryoablation-performed/
  9. American Cancer Society Team. “Can Colorectal Cancer Be Prevented?” American Cancer Society, Jun. 2020, https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/prevention.html

Dr. Carlos Bautista is a Board Certified Medical Doctor. He received his Medical Degree from Universidad Autónoma de Baja California and has more than 20 years of experience working with Alternative Medicine to treat cancer, autoimmune diseases, chronic degenerative diseases, and infectious diseases. He opened Immunity Therapy Center in 2007 with the goal of providing the highest quality medical care for more than 5,000 patients.

At Immunity Therapy Center, our goal is to provide objective, updated, and research-based information on all health-related topics. This article is based on scientific research and/or other scientific articles. All information has been fact-checked and reviewed by Dr. Carlos Bautista, a Board Certified Medical Doctor at Immunity Therapy Center. All information published on the site must undergo an extensive review process to ensure accuracy. This article contains trusted sources with all references hyperlinked for the reader's visibility.