Anal Fissure

What is an anal fissure?

An anal fissure is a tear in the lining of the lower rectum (anal canal) that causes pain during bowel movements. Anal fissures don't lead to more serious problems.

Most anal fissures heal with home treatment after a few days or weeks. These are called short-term (acute) anal fissures. If you have an anal fissure that hasn't healed after 8 to 12 weeks, it is considered a long-term (chronic) fissure. A chronic fissure may need medical treatment.

Anal fissures are a common problem. They affect people of all ages.

What causes it?

Anal fissures are caused by injury or trauma to the anal canal. Injury can happen when:

• You pass a large stool.
• You are constipated and try to pass a hard stool.
• You have repeated diarrhea.
• You give birth. (Childbirth can cause trauma to the anal canal.)

Fissures can also be caused during a rectal exam, during anal intercourse, or from a foreign object. In some cases, a fissure may be caused by a health problem, such as Crohn's disease.

Tension in the two muscular rings (anal sphincters) controlling the anus may also be a cause of fissures.

What are the symptoms?

The symptoms of an anal fissure may include:

• A sharp, stinging, or burning pain during bowel movements. Pain from a fissure may be quite severe. It may last from a few minutes to a few hours after a bowel movement.
• Itching.
• Bleeding. You may see a small spot of bright red blood on toilet tissue or a few drops in the toilet bowl. The blood from a fissure is separate from the stool. (Very dark, tarry stools or dark red blood mixed with stool may be a sign of a more serious problem.) Tell your doctor if you have any bleeding with a bowel movement.

Sometimes an anal fissure may bleed from time to time but cause no other symptoms.

How is it diagnosed?

A doctor can diagnose an anal fissure based on your symptoms and a physical exam. The exam may include:

• Looking at the anal canal by gently separating the buttocks.
• A digital rectal exam. The doctor inserts a gloved finger into the anal canal.
• Anoscopy. This involves using a short, lighted scope to look into the anal canal.

The doctor may wait until the fissure has started to heal before doing a rectal exam or anoscopy. If an exam needs to be done right away, medicine can be used to numb the area.

During an exam, a doctor can also find out whether another condition may be causing the fissure. Having several fissures or having one or more in an area of the anus where fissures usually don't occur can be a sign of a more serious problem, such as inflammatory bowel disease (IBD) or Crohn's disease.

How can you care for yourself at home?

• If your doctor prescribed cream or ointment, use it exactly as prescribed. Contact your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• Be safe with medicines. Read and follow all instructions on the label.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
• Talk with your doctor about whether to try a nonprescription cream such as zinc oxide, Preparation H, or 1% hydrocortisone for a short time. These may help soothe anal tissues.
• Your doctor may recommend an over-the-counter laxative, such as Miralax, Milk of Magnesia, or Ex-Lax. Read and follow all instructions on the label, and do not use these medicines on a long-term basis.
• Sit in a few inches of warm water (sitz bath) 3 times a day and after bowel movements. The warm water helps the area heal and eases discomfort. Do not put soaps, salts, or shampoos in the water.
• Avoid constipation:
  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
  • Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • Get some exercise every day. Build up slowly to 30 to 60 minutes a day on 5 or more days of the week.
  • Take a fiber supplement, such as Benefiber or Metamucil, every day if needed. Read and follow all instructions on the label.
  • Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. Take your time and don't strain when having a bowel movement. But don't sit on the toilet for more than 10 minutes.
• Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position.
• Use baby wipes or medicated pads, such as Preparation H or Tucks, instead of toilet paper to clean after a bowel movement. These products don't irritate the anus.

How is an anal fissure treated?

Most anal fissures heal in a few days or weeks with home treatment. But if a fissure lasts more than 8 to 12 weeks, you may need prescription medicines. These may include cream or gel ointment medicines or botulinum toxin (Botox) injections for pain or to relax the anal sphincter.

In rare cases, surgery may be needed. The most common surgery is called a lateral internal sphincterotomy. In this surgery, the doctor makes a cut in the ring of muscle (anal sphincter) that controls the anus. The anal sphincter muscles then relax, which reduces pain and spasms and allows the fissure to heal.