Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisTreatmentPrognosisCopingNext in Anal Fissure GuideHow Anal Fissure Is Treated
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Coping
Next in Anal Fissure Guide
The anus is the opening in the bottom where stool passes out of the body. When the skin in the anus develops a tear or a crack, it is called an anal fissure.
Anal fissures may cause both bleeding and pain. The bleeding may be bright red and appear in the toilet or on toilet paper after wiping. Fissures can cause pain during and after a bowel movement that ranges from mild to severe.
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This article includes a description of an anal fissure and how it is diagnosed and treated.
Types of Anal Fissure
Anal fissures may be put into two types: acute and chronic.
Acute Anal Fissure
Chronic Anal Fissure
A chronic anal fissure is one that lasts more than six weeks. In a chronic fissure, the more conservative,at-home treatmentshaven’t worked. In that case, injections or surgery may be needed to heal it.
Anal Fissure Symptoms
Symptoms of an anal fissure can include:
There are several potential causes and risk factors for developing an anal fissure. These include:
Anal fissures are common in infants and children, but they can happen to anyone at any stage of life. In babies and kids, the cause is usually passing a large, hard stool.
Tests to look inside the anal canal usually aren’t used because they can cause more discomfort. Looking at the area should be done gently and as briefly as possible.
Blood in the StoolBlood in the stool, on toilet paper after wiping, or in the toilet bowl is never normal. Common causes for blood includehemorrhoids(swollen and inflamed veins in the anus or rectum) and fissures, but it is important to rule out other, more serious reasons. Even if blood has been seen in the stool before, it should be discussed with a healthcare professional.
Blood in the Stool
Blood in the stool, on toilet paper after wiping, or in the toilet bowl is never normal. Common causes for blood includehemorrhoids(swollen and inflamed veins in the anus or rectum) and fissures, but it is important to rule out other, more serious reasons. Even if blood has been seen in the stool before, it should be discussed with a healthcare professional.
Treatment usually starts with conservative measures and if the fissure doesn’t get better, more invasive therapies might be tried.
Comfort Measures
A healthcare professional may suggest addingEpsom salts(magnesium sulfate salts often used for soaking) to the water. A sitz bath might be used for about 20 minutes at a time, several times a day.
Treating Constipation
If the reason for the fissure is from having hard bowel movements, making stools softer and easier to pass may help.Drinking more water, eating foods containing fiber, or usingfiber supplements,stool softeners, orlaxativesmight be helpful. How much fiber and which fiber supplement to use should be talked over with a healthcare professional.
For kids, it’s important to ensure that they’re not holding stool because going to the bathroom is painful. Holding stool can lead to a worsening of the constipation that caused the fissure in the first place.
Medications
Some medications might be used directly on the fissure to help with the pain and/or promote healing.
Topicallidocaineis another medication that might help with painful bowel movements. This cream is applied with a clean or gloved finger or an applicator. It can be used twice a day.
Calcium channel blockers are a type of medication that treats blood pressure. They can also relax the muscles in the anus, which prevents spasms and discomfort. They might be givenorallyor topically (applied directly to the site). Using the topical form helps prevent side effects.
Botox Injections
Surgery
An operation, such as an anocutaneous flap (transferring a flap of living skin tissue onto the fissure), fissurectomy (cutting away the fissure), orsphincterotomy, might be used for anal fissures that won’t heal up with other measures.
The surgery most often used is a lateral internal sphincterotomy. This involves cutting the muscles in the anal sphincter, which helps it heal cleanly. Surgery is effective at treating a fissure, but any surgery carries risks. Surgery along with medications might be more effective in the long run.
Most cases of anal fissure will improve with the at-home measures such as avoiding constipation and/or some medications for pain and spasms.
Some people will develop a chronic fissure that may need to be treated with surgery. However, surgery has a good chance of curing the fissure. To prevent a chronic, recurring condition, it’s important is to keep up the self-care measures at home.
An anal fissure is painful and upsetting. The anal sphincter can take time to heal because it’s constantly in use for bowel movements. Seeking care early after having symptoms and following your healthcare provider’s recommendations can help. Some people may also prefer to ask for a referral to a digestive disease specialist, such as agastroenterologist.
Dealing with digestive problems and describing the symptoms can be embarrassing. It’s important to remember that healthcare professionals help their patients with digestive conditions all the time. Asking questions about anything that is unclear will help in getting on the right track.
Summary
An anal fissure is a crack or a tear in the anal canal. The treatment can include managing constipation, applying topical medications, and, in some cases, having surgery. Most people do well with conservative measures, and the fissure will not recur.
A Word From Verywell
Anal fissures can be painful, and seeing blood in or on the stool can be a shock. However, it’s important to remember that anal fissures are a common problem and most people do well with conservative treatments.
The fissure is likely to heal and not recur. However, if this condition does become chronic or come back after treatment, surgical options work well and can provide relief, if needed.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol.2020;33(1):9-18. doi:10.20524/aog.2019.0438.National Health Service.Anal fissure.Azadi A, Jafarpour Fard P, Sagharjoghi Farahani M, Khodadadi B, Almasian M.Anal tuberculosis: A non-healing anal lesion.IDCases. 2018;12:25-28. doi:10.1016/j.idcr.2018.02.012Jamshidi R.Anorectal complaints: Hemorrhoids, fissures, abscesses, fistulae.Clin Colon Rectal Surg. 2018;31(2):117-120. doi:10.1055/s-0037-1609026.Stewart DB Sr, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR.Clinical practice guideline for the management of anal fissures.Dis Colon Rectum. 2017;60(1):7-14. doi:10.1097/DCR.0000000000000735.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol.2020;33(1):9-18. doi:10.20524/aog.2019.0438.National Health Service.Anal fissure.Azadi A, Jafarpour Fard P, Sagharjoghi Farahani M, Khodadadi B, Almasian M.Anal tuberculosis: A non-healing anal lesion.IDCases. 2018;12:25-28. doi:10.1016/j.idcr.2018.02.012Jamshidi R.Anorectal complaints: Hemorrhoids, fissures, abscesses, fistulae.Clin Colon Rectal Surg. 2018;31(2):117-120. doi:10.1055/s-0037-1609026.Stewart DB Sr, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR.Clinical practice guideline for the management of anal fissures.Dis Colon Rectum. 2017;60(1):7-14. doi:10.1097/DCR.0000000000000735.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol.2020;33(1):9-18. doi:10.20524/aog.2019.0438.National Health Service.Anal fissure.Azadi A, Jafarpour Fard P, Sagharjoghi Farahani M, Khodadadi B, Almasian M.Anal tuberculosis: A non-healing anal lesion.IDCases. 2018;12:25-28. doi:10.1016/j.idcr.2018.02.012Jamshidi R.Anorectal complaints: Hemorrhoids, fissures, abscesses, fistulae.Clin Colon Rectal Surg. 2018;31(2):117-120. doi:10.1055/s-0037-1609026.Stewart DB Sr, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR.Clinical practice guideline for the management of anal fissures.Dis Colon Rectum. 2017;60(1):7-14. doi:10.1097/DCR.0000000000000735.
Gardner IH, Siddharthan RV, Tsikitis VL.Benign anorectal disease: hemorrhoids, fissures, and fistulas.Ann Gastroenterol.2020;33(1):9-18. doi:10.20524/aog.2019.0438.
National Health Service.Anal fissure.
Azadi A, Jafarpour Fard P, Sagharjoghi Farahani M, Khodadadi B, Almasian M.Anal tuberculosis: A non-healing anal lesion.IDCases. 2018;12:25-28. doi:10.1016/j.idcr.2018.02.012
Jamshidi R.Anorectal complaints: Hemorrhoids, fissures, abscesses, fistulae.Clin Colon Rectal Surg. 2018;31(2):117-120. doi:10.1055/s-0037-1609026.
Stewart DB Sr, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR.Clinical practice guideline for the management of anal fissures.Dis Colon Rectum. 2017;60(1):7-14. doi:10.1097/DCR.0000000000000735.
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