Anal fissure

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Anal fissure
Anal fissure
Synonyms	Fissure in ano, rectal fissure
Pronounce	N/A
Specialty	N/A
Symptoms	Pain during bowel movements, bleeding
Complications	Chronic fissure, anal fistula
Onset	Acute or chronic
Duration	Weeks to months
Types	N/A
Causes	Trauma, constipation, diarrhea
Risks	Constipation, childbirth, Crohn's disease
Diagnosis	Physical examination, anoscopy
Differential diagnosis	Hemorrhoids, anal abscess, anal cancer
Prevention	High-fiber diet, hydration, stool softeners
Treatment	Dietary fiber, sitz baths, topical anesthetics, surgery
Medication	Topical nitroglycerin, calcium channel blockers
Prognosis	Good with treatment
Frequency	Common
Deaths	N/A

Anal fissure, also known as fissura ani, is a small tear in the anal canal, typically causing pain and discomfort during and after defecation. The condition often leads to rectal bleeding, particularly after bowel movements. The sharp, intense pain may last for minutes to hours, making defecation a distressing experience.

Causes

The exact cause of an anal fissure is not always clear, but several factors contribute to its development:

• Constipation and straining during bowel movement
• Excessive tension in the anal sphincter
• Reduced blood circulation to the anal region
• Skin irritation due to improper drying after bathing or swimming
• Excessive stretching of the anal canal
• Pregnancy and childbirth
• Delayed diaper changes in infants

Once a fissure occurs, it may take 6 weeks to 3 months to fully heal. During this period, the fissure can reopen easily, leading to recurring symptoms.

Treatment

Management of anal fissures involves a combination of medications, lifestyle changes, and, in some cases, surgery. Treatment options include:

Medications

A healthcare provider may prescribe various treatments to relieve pain, reduce inflammation, and promote healing:

• Topical pain-relief ointments ‚Äì Medications containing local anesthetics can help reduce pain and discomfort.
• Suppositories ‚Äì Rectal medications that provide relief by coating and soothing the affected area.
• Laxatives ‚Äì To prevent constipation and ease stool passage.
• Zinc-based ointments ‚Äì Help protect and contract the skin, promoting faster healing.
• Muscle relaxants ‚Äì Medications such as nitroglycerin or calcium channel blockers may help relax the anal sphincter and improve blood flow.

Home Remedies and Self-Care

Patients can adopt several measures to promote healing and prevent recurrence:

• Eating a high-fiber diet, including whole grains, vegetables, and fruits.
• Staying hydrated by drinking plenty of fluids.
• Using a stool softener if necessary.
• Practicing proper hygiene and ensuring the anal area remains dry.
• Taking warm sitz baths 2‚Äì3 times daily to relax the anal muscles and promote healing.

Chronic Fissure Treatment

If an anal fissure persists for more than 6 weeks, it is classified as chronic. Treatment options for chronic fissures include:

• Botulinum toxin (Botox) injection ‚Äì Helps relax the anal sphincter, reducing pressure and promoting healing.
• Lateral internal sphincterotomy ‚Äì A surgical procedure where a small portion of the anal sphincter is cut to reduce tension and improve healing.
• Dilation procedures ‚Äì Involves gentle stretching of the anal canal to reduce pressure.

Prevention

To prevent recurrence, patients should take certain precautions for up to three months after healing. Recommended steps include:

Dietary and Lifestyle Changes

• Maintain a high-fiber diet to prevent constipation.
• Avoid foods that can harden stool, such as white bread, cheese, and caffeine.
• Drink enough water daily to keep bowel movements soft.
• Engage in regular physical activity to promote healthy digestion.

Proper Hygiene Practices

• Ensure the anal area is completely dry after bathing or swimming.
• Use soft toilet paper or baby wipes instead of rough tissues.
• Wash the anal region with warm water rather than wiping aggressively.

Sitz Baths and Skin Care

• Soak in a tub with warm water and baking soda for 15‚Äì20 minutes to soothe irritation.
• Apply a thin layer of oil, such as olive oil or coconut oil, to keep the skin soft and prevent tearing.

When to See a Doctor

While most anal fissures heal on their own, medical consultation is necessary if:

• Pain persists for more than 6 weeks.
• Bleeding occurs frequently.
• The fissure does not improve despite treatment.
• A lump or swelling is present near the anus.

If blood is observed in the stool, it is essential to rule out other conditions such as hemorrhoids or colon cancer.

Gallery

• 

  Fissurectomy wound - initial stage

• 

  Fissurectomy wound after 3 weeks

• 

  Fissurectomy wound after 12 weeks

See Also

• Constipation
• Hemorrhoids
• Colorectal surgery
• Digestive system disorders
• Sitz bath