An anal fissure is a small tear or crack in the inner lining of the anus. It typically causes pain, bleeding, and discomfort during bowel movements. If untreated, it can become chronic and negatively impact quality of life. This article provides a comprehensive overview of anal fissures.
What is an Anal Fissure?
An anal fissure is a wound caused by a tear in the skin or mucosa around the anus. It usually happens due to straining during bowel movements. Common causes include passing hard stools, constipation, or prolonged diarrhea.
There are two types of anal fissures:
- Acute Anal Fissure: A new fissure lasting less than 6 weeks.
- Chronic Anal Fissure: A fissure persisting more than 6 weeks, often resistant to treatment.
Symptoms of Anal Fissure
Common symptoms include:
- Sharp, burning pain during bowel movements
- Pain continuing after defecation, sometimes lasting hours
- Bright red blood on stool or toilet paper
- Itching and irritation around the anus
- Small skin tags near the fissure (sentinel piles)
Pain severity depends on fissure depth and duration. Chronic fissures may cause spasms and increased pain.
How is an Anal Fissure Treated?
Treatment depends on the severity and duration of the fissure:
1. Conservative Treatment (First Stage):
- Diet rich in fiber
- Drinking plenty of fluids (2–2.5 liters per day)
- Warm sitz baths to relax muscles
- Topical creams to soften the area and relax sphincter muscles
- Pain relievers as needed
2. Medical Treatment:
- Topical nitroglycerin or calcium channel blockers to improve blood flow and healing
- Botulinum toxin (Botox) injections to relax the internal anal sphincter temporarily
3. Surgical Treatment:
- Lateral internal sphincterotomy involves cutting part of the internal anal sphincter to relieve muscle spasm
- Highly effective for chronic, treatment-resistant fissures
Causes of Anal Fissure
Several factors contribute to fissure formation:
| Cause | Explanation |
|---|---|
| Constipation | Hard stool tears the mucosa during passage |
| Prolonged diarrhea | Irritation of tissues around the anus |
| Excessive straining | High pressure during bowel movements |
| Childbirth trauma | Pressure on anus during vaginal delivery |
| Anal muscle spasm | Muscle tightness reduces blood flow, delaying healing |
| Inflammatory bowel disease | Diseases like Crohn’s may increase risk |
Constipation and poor toileting habits are major risk factors.
Rectal Bleeding
Blood from the anus during or after bowel movements may indicate fissures or other issues:
| Blood Color | Possible Causes |
|---|---|
| Bright red | Hemorrhoids, anal fissure, anal trauma |
| Dark red/maroon | Inflammation in the upper colon, diverticulitis |
| Black (melena) | Bleeding from stomach or small intestine |
Anal Pain
Pain around the anus can be acute or chronic, worsening with sitting or bowel movements. Common causes include:
- Anal fissure: Sharp, stabbing pain during defecation
- Perianal abscess: Collection of pus causing severe throbbing pain
- Pelvic floor spasms: Sudden, temporary muscle cramps with unknown cause
Anal Itching (Pruritus Ani)
An uncomfortable, repetitive itching around the anus may be caused by:
- Hygiene issues (too little or too much cleaning)
- Skin conditions (eczema, psoriasis)
- Parasitic infections (pinworms)
- Fungal or bacterial infections
- Proctologic diseases (hemorrhoids, fissures)
- Systemic diseases (diabetes, liver disorders)
Who is More Likely to Get Anal Fissures?
- People with constipation
- Pregnant or postpartum women
- Babies and young children
- Individuals with inflammatory bowel diseases
- Those who strain excessively
- Sedentary individuals
Difference Between Acute and Chronic Fissures
| Feature | Acute Fissure | Chronic Fissure |
|---|---|---|
| Duration | Less than 6 weeks | More than 6 weeks |
| Appearance | Fresh, superficial tear | Deeper tear with skin tags |
| Response to Treatment | Usually heals easily | Often resistant to treatment |
| Pain | Limited to bowel movements | Can last hours after bowel movement |
How is Anal Fissure Diagnosed?
Diagnosis is usually made through physical examination and patient history. Additional methods include:
- Anoscopy: To view fissure in detail
- Further tests if chronic or recurrent fissures suggest underlying disease
Prevention of Anal Fissures
- Drink enough water daily
- Eat a high-fiber diet
- Develop regular bowel habits
- Avoid excessive straining
- Increase physical activity
- Avoid prolonged sitting on the toilet
What Happens if Treatment is Delayed?
- Fissures can become chronic
- Muscle spasms and poor blood flow may worsen
- Persistent pain and bleeding
- Surgery may become necessary
Early treatment and lifestyle changes reduce the need for surgery.
Post-Surgical Recovery
| Stage | Duration | Care Recommendations |
|---|---|---|
| First days after surgery | 3–5 days | Pain control, warm baths |
| Initial healing | 1–2 weeks | Regular bowel movements, avoid constipation |
| Full recovery | 4–6 weeks | Follow-up appointments, hygiene |
Frequently Asked Questions
Can anal fissures heal on their own?
Acute fissures detected early may heal with lifestyle changes and conservative treatment. Chronic fissures usually require medical intervention.
Do anal fissures cause cancer?
No, anal fissures do not lead to cancer. However, similar symptoms may indicate serious conditions that need evaluation.
When should I see a doctor?
If pain, bleeding, or constipation lasts more than two weeks, seek medical advice.
Can fissures recur after surgery?
Recurrence is rare if proper surgery and lifestyle adjustments are made, but poor habits may cause new fissures.
This content is for informational purposes only and is based on current scientific knowledge at the time of preparation. For any symptoms, diagnosis, or treatment, please consult your healthcare provider or an authorized health institution.
