What is an anal fissure?
An anal fissure is a small cut or tear in the lining of the
anus. The crack in the skin exposes the muscle tissue underneath, causing severe
pain and bleeding during and after bowel movements. An anal fissure may occur
as a result of childbirth, straining during bowel movements, or long bouts of
constipation or diarrhea.
An anal fissure can affect people of all ages, but it’s most
often seen in infants and young children. An anal fissure usually isn’t a
serious condition. In most cases, the tear heals on its own within four to six
weeks. 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.
What are the symptoms of an anal fissure?
An anal fissure may cause one or more of the following
- a visible tear in the skin around the anus
- a skin tag, or small lump of skin, next to the tear
- sharp pain in the anal area during bowel
- streaks of blood on stools or on tissue paper
- burning or itching in the anal area
What causes an anal fissure?
An anal fissure most often occurs when passing large or hard
stools. Chronic constipation or frequent diarrhea can also tear the skin around
the anus. Other common causes include:
- Crohn’s disease or another inflammatory bowel
- 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
Who is at risk for an anal fissure?
For unknown reasons, anal fissures are common during
infancy. They occur in approximately 80 percent
of babies during the first year of life. 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 an inflammatory bowel disease, 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.
How is an anal fissure diagnosed?
A doctor can usually diagnose an anal fissure simply by
examining the area around the anus. However, they may want to perform a digital
rectal exam to confirm the diagnosis. During this exam, the doctor will insert
an endoscope or anoscope into your rectum to make it easier to see the tear. These
medical instruments are thin tubes with attached cameras and lights that allow
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.
How is an anal fissure treated?
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
- taking fiber supplements and increasing intake
of 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, such as
Cortisone-10, to the anus to promote blood flow to the area and promote healing
- applying topical pain relievers, such as
Anusol-HC and Lidocaine, to the anus to ease discomfort
Your doctor may also suggest a brand of calcium channel
blocker ointment that 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 the 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 is a surgical procedure that
involves making a small incision in the anal sphincter to relax the muscle,
which 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 rectal 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.
How can an anal fissure be prevented?
An anal fissure can’t always be prevented, but you can
reduce your risk of getting one by taking the following preventive measures:
- changing diapers frequently in infants
- 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