Anal fissure



What is anal fissure?

An anal fissure is a small cut or tear in the lining of the lower rectum (anal canal), causing severe pain and bleeding during and after bowel movements. An acute anal fissure looks like a fresh tear, as a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla).

An anal fissure does not usually cause serious condition. In most cases, the tear heals on its own within four to six weeks (acute anal fissure). Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. If an anal fissure doesn’t improve with these treatments and your anal fissure hasn’t healed after 8 to 12 weeks, it is considered a long-term (chronic) fissure. A chronic fissure may need medication or even surgery for the prevention of recurrence or damaged surrounding muscles.

How common is anal fissure?

This health condition is extremely common. It commonly affects young infants. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.


What are the symptoms of anal fissure?

The common symptoms of anal fissure are:

  • Spot of red blood on toilet paper after a bowel movement or a few drops in the toilet bowl. The bright red blood from a fissure is separate from the stool and the color is bright red blood.
  • Pain, sometimes severe, during bowel movements.
  • Pain after bowel movements that can last up to several hours.
  • Itching or irritation around the anus.
  • A visible crack in the skin around the anus.
  • A small lump or skin tag on the skin near the anal fissure.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes anal fissure?

Common causes of anal fissure include:

  • Passing large or hard stools;
  • Constipation and straining during bowel movements;
  • Chronic diarrhea;
  • Inflammation of the anorectal area;
  • Crohn’s disease or another inflammatory bowel disease;
  • decreased blood flow to the anorectal area;
  • It can cause trauma to the anal canal.

In rare cases, an anal fissure may develop due to:

  • Anal cancer;
  • HIV;
  • Tuberculosis;
  • Syphilis;
  • Herpes.

Risk factors

What increases my risk for anal fissure?

There are many risk factors for anal fissure, such as:

  • Infancy;
  • Aging;
  • Constipation;
  • Childbirth;
  • Crohn’s disease;
  • Anal intercourse.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is anal fissure diagnosed?

Your doctor will ask about your symptoms and do a physical exam through looking at the fissure by gently separating the buttocks to diagnose an anal fissure. In some cases, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal.

However, if this is too painful for you, your doctor may wait when the fissure has started to heal before doing a rectal exam or anoscopy – This involves using a short, lighted scope to look into the anal canal.

During an exam, a doctor can also find out whether another condition may be causing the fissure such as Crohn’s disease or another inflammatory bowel disease. Your doctor may recommend further testing, including:

  • Flexible sigmoidoscopy. This test may be done if you’re younger than 50 and have no risk factors for intestinal diseases or colon cancer.
  • Colonoscopy. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.

How is anal fissure treated?

An acute anal fissure often heals within a few weeks by changing your eating habits, such as increasing your intake of fiber and fluids. This action helps to keep your stool soft. If your symptoms persist, you’ll likely need further treatment:

  • Externally applied nitroglycerin (Rectiv);
  • Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine);
  • Botulinum toxin type A (Botox) injection;
  • Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem);
  • This treatment is highly recommended in a chronic anal fissure case.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage anal fissure?

The following lifestyles and home remedies might help you cope with anal fissure:

  • Add fiber to your diet.Involving foods are high in fiber in your diet each day such as fruits, vegetables, beans, and whole grains.
  • Drink adequate fluids.Fluids help prevent constipation.
  • Exercise regularly.Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure.
  • Avoid straining during bowel movements.Straining creates pressure, which can open a healing tear or cause a new tear, you should schedule time each day for a bowel movement. Take your time. Don’t strain.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.



Review Date: November 5, 2016 | Last Modified: January 4, 2017

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