What Is an Anal Fissure? Symptoms and Treatment

Main Keywords: anal fissure, anal tear, anal fissure treatment, fissure treatment

Supporting Keywords: chronic anal fissure, acute anal fissure, anal fissure symptoms, anal fissure causes, anal fissure surgery, Botox for anal fissure, lateral internal sphincterotomy, pain during bowel movements, anal pain and bleeding, tear in the anus, anal fissure operation

An anal fissure — commonly described as a tear in the anus — is a small tear in the lining of the anal canal. Sharp pain during bowel movements, followed by a burning sensation that persists afterwards, is among the most typical symptoms of an anal fissure.

Anal fissures are a very common anal condition. Constipation, hard stools and excessive straining are among the most important causes. With appropriate treatment in the early period, healing can be achieved, whereas long-standing chronic anal fissures may require different treatment methods.

What Causes an Anal Fissure?

The most common cause of an anal fissure is trauma to the area during the passage of hard, bulky stool through the anal canal.

Conditions that can contribute to the development of an anal fissure include:

Constipation

Hard stools

Excessive straining

Prolonged diarrhea

Trauma in the postpartum period

Irregular bowel habits

Once an anal fissure has formed, the pain that occurs during bowel movements can cause the muscles in the anal region to contract reflexively. This contraction can reduce blood flow to the area, making it harder for the wound to heal. A cycle of pain — spasm — impaired healing can thus develop.

What Are the Symptoms of an Anal Fissure?

The most characteristic symptom of an anal fissure is severe anal pain during bowel movements. Patients often describe the pain as sharp, stabbing or cutting. The pain can continue for some time after the bowel movement has ended.

Other anal fissure symptoms include:

Anal pain during bowel movements

Burning or pain that continues after bowel movements

Bright red blood on the toilet paper

A small amount of blood on the surface of the stool

Tenderness around the anus

Postponing bowel movements out of fear of pain

Postponing bowel movements because of pain, in particular, can worsen constipation and make it even harder for the fissure to heal.

Are Anal Fissures and Hemorrhoids the Same Disease?

No. Anal fissures and hemorrhoids are different diseases.

Hemorrhoids are related to the enlargement of vascular structures in the anal region and the complaints this causes, whereas an anal fissure is a tear in the lining of the anal canal.

Because bleeding and pain at the anus can occur in both conditions, patients can confuse them with each other. For this reason, when there is pain or bleeding in the anal region, a general surgery evaluation is important to determine the cause of the complaint.

What Is the Difference Between an Acute and a Chronic Anal Fissure?

Newly developed anal fissures are considered acute anal fissures. During this period, healing can be achieved by regulating bowel habits and with appropriate medical treatment.

Fissures that persist for a long time without healing can become chronic anal fissures. In a chronic fissure, structural changes can develop around the wound and persistent spasm of the anal muscles may be present. In this situation, correcting constipation alone may not be enough and additional treatments may be needed.

How Is an Anal Fissure Diagnosed?

In most patients, an anal fissure can be diagnosed by evaluating the complaints and examining the anal region.

The purpose of the examination is not only to see the fissure. It is also necessary to make the differential diagnosis of other anorectal conditions that can cause symptoms resembling an anal fissure, such as hemorrhoids, anal abscess or anal fistula.

Particularly in fissures that are recurrent, located in unusual positions or unresponsive to standard treatments, underlying diseases may need to be investigated.

How Is an Anal Fissure Treated?

Anal fissure treatment is planned according to whether the disease is acute or chronic, the duration of the complaints and the examination findings.

One of the main goals of treatment is to make the stool soft and regular. For this purpose, adequate fluid intake, a fiber-rich diet and, when needed, stool-regulating treatments may be recommended.

Warm sitz baths can help reduce discomfort and muscle spasm in the anal region in some patients.

In addition, local medication prescribed by the doctor can be used to reduce anal muscle spasm and support the healing of the fissure.

Botox Treatment for Anal Fissure

In some anal fissures that do not heal despite medical treatment, botulinum toxin (Botox) injection can be a treatment option.

The aim of Botox treatment is to temporarily relax the muscle surrounding the anal canal. By reducing muscle spasm, the goal is to support blood flow to the area and the healing process of the fissure.

However, not every anal fissure patient is suitable for Botox treatment. The choice of treatment should be based on the patient’s examination findings.

When Is Anal Fissure Surgery Necessary?

Surgical treatment may come onto the agenda for long-standing, chronic anal fissures that do not heal despite appropriate medical treatment.

One of the most commonly performed surgical methods is lateral internal sphincterotomy (LIS). In this operation, a specific portion of the internal muscle surrounding the anal canal is released. The aim is to reduce the high pressure and spasm in the anal canal, allowing the fissure to heal.

The need for surgical treatment and the choice of method should be individualized. In particular, anal sphincter function and the patient’s personal risk factors must be evaluated.

Do Anal Fissures Heal on Their Own?

Some newly developed anal fissures can heal by resolving constipation, softening the stool and using appropriate supportive treatments. However, if the complaints persist for a long time, the fissure can become chronic.

For this reason, an examination is recommended especially if there is severe pain during bowel movements, recurrent rectal bleeding or long-standing anal pain.

Can an Anal Fissure Recur?

An anal fissure can develop again after treatment. Ongoing constipation, hard stools and excessive straining in particular can increase the risk of recurrence.

An important part of treatment is therefore maintaining regular, comfortable bowel habits over the long term.

When Should You See a General Surgeon?

Pain or bleeding at the anus does not always mean an anal fissure.

In particular, if there is:

Severe or recurrent anal pain,

Constant pain during bowel movements,

Bleeding from the anus,

Swelling or discharge around the anus,

Complaints that have not healed for a long time,

an evaluation by a General Surgery specialist is advisable.

With the correct diagnosis and treatment appropriate to the stage of the disease, an anal fissure can be successfully brought under control in most patients.

Frequently Asked Questions

What is an anal fissure?

An anal fissure is a small tear in the lining of the anal canal, commonly described as a tear in the anus.

What causes an anal fissure?

The most common causes are constipation and hard stools. Excessive straining, prolonged diarrhea and local trauma can also contribute to the development of a fissure.

What is the most important symptom of an anal fissure?

The most typical symptom is sharp anal pain that begins during bowel movements, with burning or pain that can continue afterwards.

Do anal fissures bleed?

Yes. A small amount of bright red blood is usually seen on the toilet paper or on the surface of the stool. However, since rectal bleeding can have other causes, recurrent bleeding should be evaluated.

Can an anal fissure be treated without surgery?

Particularly in acute anal fissures, healing without surgery is possible by regulating bowel habits and with appropriate medical treatment.

Can Botox be used for an anal fissure?

In suitable patients, botulinum toxin injection can be used to temporarily reduce anal muscle spasm.

What is anal fissure surgery?

One of the methods that can be used for chronic, treatment-resistant anal fissures is lateral internal sphincterotomy. The decision for surgery should be based on the patient’s examination findings and risk factors.

How are an anal fissure and hemorrhoids told apart?

The symptoms can sometimes be similar. The definitive distinction is made by examination.

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