An anal fissure is a small cut or tear in the lining of the anus. The crack in the skin causes severe pain and some bright red bleeding during and after bowel movements. At times the fissure is deep enough to expose the muscle tissue underneath. An anal fissure may occur as a result of childbirth, straining during bowel movements, or long bouts of constipation or diarrhea. Anal fissures can also be the result of certain medical conditions such as inflammatory bowel disease (IBD), infection, and cancer.
An anal fissure can affect people of all ages, and it’s often seen in infants and young children. Constipation is a common problem in these age groups. An anal fissure usually isn’t a serious condition. In most cases, the tear heals on its own within four to six weeks. In cases where the fissure persists beyond eight weeks, it’s considered chronic, or long term.
Certain treatments can promote healing and help relieve discomfort, including stool softeners and topical pain relievers. If an anal fissure doesn’t improve with these treatments, surgery may be required. Or your doctor may need to look for other underlying disorders that can cause anal fissures.
An anal fissure may cause one or more of the following symptoms:
- a visible tear in the skin around your anus
- a skin tag, or small lump of skin, next to the tear
- sharp pain in the anal area during bowel movements
- streaks of blood on stools or on tissue paper after wiping
- burning or itching in the anal area
An anal fissure most often occurs when passing large or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around your anus. Other common causes include:
- Crohn’s disease or another IBD
- straining during childbirth
- decreased blood flow to the anorectal area
- overly tight or spastic anal sphincter muscles
In rare cases, an anal fissure may develop due to:
- anal cancer
Anal fissures are common during infancy. Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. During and after childbirth, women are at risk for anal fissures due to straining during delivery.
People with IBD, such as Crohn’s disease, also have a higher risk of developing anal fissures. The inflammation that occurs in the intestinal lining makes the tissue around the anus more prone to tearing. People who frequently experience constipation are at an increased risk for anal fissures as well. Straining and passing large, hard stools are the most common causes of anal fissures.
A doctor can usually diagnose an anal fissure simply by examining the area around the anus. However, they may want to perform a rectal exam to confirm the diagnosis.
During this exam, the doctor may insert an anoscope into your rectum to make it easier to see the tear. This medical instrument is a thin tube that allows doctors to inspect the anal canal. Using an anoscope may also help your doctor find other causes of anal or rectal pain such as hemorrhoids. In some cases of rectal pain, you may need an endoscopy for better evaluation of your symptoms.
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Most anal fissures don’t require extensive treatment. However, certain home remedies can help promote healing and relieve uncomfortable symptoms. You can treat an anal fissure at home by:
- using over-the-counter stool softeners
- drinking more fluids
- taking fiber supplements and eating more fibrous foods, such as raw fruits and vegetables
- taking warm baths called sitz baths to relax the anal muscles, relieve irritation, and increase blood flow to the anorectal area
- applying a nitroglycerin ointment to the anus to promote blood flow to the area or a hydrocortisone cream, such as Cortizone 10, to help with inflammation
- applying topical pain relievers, such as lidocaine, to the anus to ease discomfort
If your symptoms aren’t relieved within two weeks of treatment, see your doctor for further evaluation. Your doctor can make sure you have the correct diagnosis and can recommend other treatments.
A calcium channel blocker ointment can relax the sphincter muscles and allow the anal fissure to heal.
Another possible treatment is Botox injections into the anal sphincter. The injections will prevent spasms in your anus by temporarily paralyzing the muscle. This allows the anal fissure to heal while preventing new fissures from forming.
If your anal fissure fails to respond to other treatments, your doctor may recommend an anal sphincterotomy. This surgical procedure involves making a small incision in the anal sphincter to relax the muscle. Relaxing the muscle allows the anal fissure to heal. This is likely to be considered if less invasive therapies have failed.
Not all anal fissures are a sign of low-fiber diets and constipation. Poorly healing fissures or those located in a position other than the posterior and midline portion of your anus may indicate an underlying disease such as tuberculosis, HIV, or anal cancer. If you have any concerns about a fissure that’s not healing despite trying conservative, at-home remedies, contact your doctor to see if you need any additional tests.
An anal fissure can’t always be prevented, but you can reduce your risk of getting one by taking the following preventive measures:
- keeping the anal area dry
- cleansing the anal area gently with mild soap and warm water
- avoiding constipation by drinking plenty of fluids, eating fibrous foods, and exercising regularly
- treating diarrhea immediately
- changing diapers frequently (for infants)