Anal Fissure

What is Anal Fissure? 

An anal fissure is a tear in the tissue of your anus. The anus is the last part of your digestive tract. It’s at the end of your rectum. It has a ring of muscle (sphincter) that opens during a bowel movement to allow stool (feces) to pass through. A fissure is caused by the anal tissue stretching too much. This can happen during a hard bowel movement. It causes pain and bleeding.

Anal fissures are not the same as hemorrhoids. But the symptoms can be similar. Hemorrhoids are inflamed blood vessels in or just outside the anus. An anal fissure is one of the most common noncancer (benign) conditions of the anus and rectum.

What Causes Anal Fissure? 

The most common cause is large or hard stools because of constipation. A fissure may also be caused by severe diarrhea, anal sex, vaginal childbirth, or an object inserted into the anus.

What Are The Symptoms? 

An anal fissure is one of the most common causes of anal pain and bleeding. Symptoms can occur a bit differently in each person.

They can include:

  • Pain during and after a bowel movement that can last for hours
  • Visible tear or cut in the area
  • Bright red bleeding during or after a bowel movement
  • The symptoms of an anal fissure may be like other health conditions. See your healthcare provider for a diagnosis.

How is it Diagnosed? 

Your healthcare provider will ask about your symptoms and health history. Your provider will give you a physical exam. The physical exam will include your anal area.

Your provider will gently separate your buttocks. The provider will look at the area around the anus for a tear and other signs of a fissure. Where the fissure is may help find the cause. Fissures most often occur in the back center of the anus. Some occur in the front center of the anus. Fissures that occur on the sides of the anus may be caused by conditions such as Crohn’s disease.

If more tests are needed, your healthcare provider may do a colonoscopy or sigmoidoscopy.

How is an Anal Fissure Treated? 

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is.

An acute anal fissure is one that lasts for a short time. It often heals within 6 weeks with simple treatment. It may heal when constipation is treated.

A chronic anal fissure is one that lasts for 6 weeks or more. This may need more treatment, such as surgery.

If your anal fissure doesn’t heal well, you may have a problem with anal pressure because of the sphincter muscle. This prevents blood from flowing normally through the blood vessels in the anus. The reduced blood flow prevents healing. Treatment may include medicine to put on the fissure and botulinum toxin shots (injections). These can help with blood flow and may help an anal fissure heal.

Other treatments include:

  • Changes in your diet.
  • Sitz baths.
  • Stool softeners.
  • Surgery

The surgery is called lateral internal sphincterotomy. During the surgery, a small cut (incision) in the muscle helps release the pressure inside the anus. This lets more blood flow through the area to heal tissues.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.