An anal fissure is a tear in the lining of the anus or anal canal (the opening through which stool passes out of the body). The fissure can be painful and may bleed.
What are the signs and symptoms of an anal fissure?
Signs and symptoms include:
Pain during, and even hours after -- a bowel movement
Constipation
Blood on the outside surface of the stool
Blood on toilet tissue or wipes
A visible crack or tear in the anus or anal canal
Burning and itch that may be painful
Discomfort when urinating, frequent urination, or inability to urinate
Foul-smelling discharge
How is an anal fissure diagnosed?
Usually your doctor can diagnose an anal fissure by visual inspection of the anus or by gentle exam with the tip of the finger.
What causes an anal fissure?
Anal fissures can be caused by trauma to the anus and anal canal. The cause of the trauma can be one or more of the following:
Chronic constipation
Straining to have a bowel movement, especially if the stool is large, hard, and/or dry
Prolonged diarrhea
Anal sex, anal stretching
Insertion of foreign objects into the anus
Causes other than trauma include:
Longstanding poor bowel habits
Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus)
Scarring in the anorectal area
Presence of an underlying medical problem: such as Crohn's disease and ulcerative colitis [types of inflammatory bowel disease]; anal cancer; leukemia; infectious diseases (such as tuberculosis); and sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV)
Decreased blood flow to the anorectal area
Anal fissures are also common in women after childbirth and in young infants.
Who is at risk for the development of anal fissures?
Anal fissures can occur in anyone at any age. Generally, the chance of an anal fissure occurring decreases as age increases. However, people who have had fissures in the past are more likely to have them in the future.
How are anal fissures treated?
The goal of treatment is to lower the pressure on the anal canal by making stools soft as well as easing discomfort and bleeding. Conservative treatments are tried first and include one or more of the following:
Preventing constipation through the use of stool softeners, increased intake of fluids while avoiding caffeine-containing products (which cause dehydration), and dietary adjustments (increase in intake of high fiber foods and fiber supplements)
Soaking in a warm bath (also called a sitz bath), 10 to 20 minutes several times a day, to promote the relaxation of the anal muscles
Cleansing the anorectal area more gently
Avoiding straining or prolonged sitting on the toilet
Using petroleum jelly to help lubricate the anorectal area
The conservative practices mentioned above heal most fissures (80 to 90 percent) within several weeks to several months. However, when treatments fail and anal fissures persist or recur other measures can be tried, including:
Using hydrocortisone-containing suppositories, foams, or creams to reduce inflammation
Applying other creams and ointments; these may include a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), nitroglycerin or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing)
Injecting botulinum toxin type A (Botox) into the anal sphincter. The injection temporarily paralyzes the anal sphincter muscle, relieving pain and promoting healing
Surgery
What does a surgical approach involve?
Before a surgical approach is considered, your doctor will re-examine you and may conduct other tests to determine why other treatments have failed to heal the fissure.
Some of the reasons why a fissure may fail to heal include scarring or muscle spasms of the internal anal sphincter muscle. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle. By doing this, pain and spasms are decreased, which allows the fissure to heal. Cutting the muscle rarely results in the loss of ability to control bowel movements. The surgery can usually be performed without an overnight stay. Pain is relieved after a few days and complete healing is achieved in a few weeks.
Is there anything I can do to prevent the development of an anal fissure?
For fissures in infants: change diapers frequently and treat constipation (if that is determined to be the cause)
For fissures in adults:
Keep the anorectal area dry
Wipe the area with soft materials, a moistened cloth, or cotton pad; avoid rough and scented toilet paper
Promptly treat all occurrences of constipation and diarrhea
