Anal Fissure

An anal fissure is a small tear or cut in the skin lining the anus which can cause pain and/or bleeding. Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increasing fiber intake or soaking in a warm-water bath. Some people with anal fissures may need medicine or, occasionally, surgery.

Symptoms

Symptoms of an anal fissure include:

  • Pain during bowel movements
  • Pain after bowel movements that can last up to several hours
  • Bright red blood on the stool or toilet paper after a bowel movement
  • A visible crack in the skin around the anus
  • A small lump or skin tag on the skin near the anal fissure
Causes

Causes of an anal fissure may include:

  • Passing large or hard stools
  • Constipation and straining during bowel movements
  • Long-lasting diarrhea
  • Anal intercourse
  • Childbirth
  • Crohn's disease or another inflammatory bowel disease
  • Anal cancer
  • HIV
  • Tuberculosis
  • Syphilis
Treatment

An acute fissure is managed with non-operative treatments and over 90 percent will heal without surgery. Bowel habits are improved with a high-fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids to avoid constipation and promote the passage of soft stools. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles. Occasionally, special medicated creams may be recommended.

A chronic fissure (lasting longer than one month) may require additional treatment. Depending on the appearance of the fissure, other medical problems, such as inflammatory bowel disease or infections may be considered, and testing may be recommended. A manometry test may be performed to determine if anal sphincter pressures are high. An examination under anesthesia may be recommended to determine a reason for lack of healing.

What does surgery involve?

Surgery is usually a small operation to cut a portion of the internal anal sphincter muscle. This helps the fissure to heal by reducing pain and spasm. Cutting this muscle rarely interferes with the ability to control bowel movements and can usually be performed without an overnight hospital stay.

Another option is an exam under anesthesia with botox injection into the sphincter muscle. This procedure will reduce the spasm in your sphincter muscle and allow the fissure to heal.