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Anal Fissure: Causes, Prevention, and Treatments

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Anal Fissure: Causes, Prevention, and Treatments

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An anal fissure is a tear or ulcer that develops in the lining of the anal canal after passing a hard motion. Read the article to learn how to avoid it.

Medically reviewed by

Dr. Infanteena Marily F.

Published At December 11, 2017
Reviewed AtApril 13, 2024

What Is an Anal Fissure?

Anal fissures are tiny rips in the thin, moist tissue that lines the anus. Stool leaves the body through the muscular orifice known as the anus after the digestive system. Anal fissures are frequently caused by straining or passing hard or big stools during a bowel movement, as well as constipation. Anal fissures usually result in pain and bleeding when an individual goes to the toilet. Additionally, one can get spasms in the anal sphincter, which is a ring of muscles at the end of the anus.

Anal fissures can occur in persons of any age, but they are more prevalent in early infants. Simple remedies, including increasing fiber intake or taking a warm-water bath, are effective for the majority of anal fissures. Anal fissure sufferers may occasionally require surgery or medication.

What Causes an Anal Fissure?

The following are the most common causes of anal fissure:

  • Constipation is the most common cause, either by itself or as part of irritable bowel syndrome.

  • Severe diarrhea.

  • Passing large and hard stools.

  • Anal sex.

  • After childbirth.

Less severe causes of an anal fissure are:

  • It may be part of a more severe condition such as Crohn's or cancer.

  • Tuberculosis.

  • Syphilis.

  • Anal cancer.

  • Tuberculosis.

What Are the Signs and Symptoms of Anal Fissure?

Anal fissure has the following manifestations:

  • Sharp pain when one passes the stool, often followed by a deep burning pain that may last several hours.

  • Lasting pain for several hours after bowel movements.

  • Bright blood is usually seen on the toilet paper.

  • It is commonly associated with severe constipation.

  • Small skin tag or lump near anal fissure.

  • Crack in the anal skin.

What Increases the Risk of Developing Anal Fissures?

  1. After Delivery: The occurrence of anal fissures in women is common after childbirth.

  2. Constipation: The risk of developing anal fissures is increased in people who strain and pass hard stools during bowel movements.

  3. Anal fissures are common in people who have anal sex.

  4. Crohn’s Disease: The lining of the anal canal is inflamed in Crohn’s disease, which is an inflammatory bowel disease. This, in turn, makes it more sensitive and increases the chance of developing anal fissures.

  5. Age: Although anal fissures can occur at any age, middle-aged adults and infants have an increased risk.

What Can Anal Fissures Be Prevented?

  • Stay well hydrated.

  • Eat many high-fiber foods such as green vegetables, fruits, and oats.

  • Exercise regularly.

  • Pay attention to the urge to pass motions.

How Is an Anal Fissure Diagnosed?

Complete medical history is obtained from the patient, and a gentle physical examination of the anal fissure is done. In most cases, an anal fissure can be diagnosed with visual inspection as it is often visible.

The cause of the anal fissure can be determined from the location itself. An underlying disorder like Crohn’s disease causes an anal fissure that has an opening on the side rather than having it on the front or back. An anal fissure can be diagnosed by:

  • Visual Examination: Acute anal fissure has a fresh tear like a paper cut, while chronic anal fissure exhibits a deep tear along with external or internal fleshy growths. In addition to physical examination, the following tests can be performed to determine the cause:

  • Anoscopy: The rectum and anus are visualized with the help of a tubular device inserted into the anus called the anoscope.

  • Flexible Sigmoidoscopy: A thin, flexible tube with a video camera is inserted into the lowest part of the colon in patients below the age of 50 years or those with no associated risk factors for colon cancer or other intestinal diseases.

  • Colonoscopy: When the patient is above the age of 50 years, has a risk of developing colon cancer, or has symptoms like diarrhea or stomach ache, then colonoscopy is recommended. A flexible tube is inserted into the rectum to visualize the colon.

What Is the Treatment of Anal Fissures?

  • Treating constipation with laxatives and stool softeners is the foremost step. Under the direction of a doctor, individuals can buy stool softener. A Sitz bath (sitting in a warm water bath) for 15 minutes once or twice a day helps in healing by relaxing the sphincter muscles.

  • Non-Surgical Treatment:

    • Glyceryl trinitrate ointment can be applied locally two to three times a day (this causes a headache, which will require Paracetamol 1000 mg tablet), preferably at bedtime. Nitroglycerine or Glyceryl trinitrate ointment is recommended when other treatments do not help. It enhances healing by increasing the blood flow to the anal fissure and relaxing the anal sphincter muscle.

    • Topical Lidocaine (anesthetic) helps relieve pain.

    • Botulinum toxin type-A injection relieves sphincter muscle spasms by paralyzing the anal sphincter muscle. Botox injections are given every three months if medical therapy fails.

    • Oral administration or external application of blood pressure medications like Diltiazem or Nifedipine brings about relaxation of the anal sphincter muscle and is recommended when Nitroglycerine ointment is ineffective.

  • Surgery: Surgery is the last resort for a few cases that do not respond to conservative management. An anal fissure is surgically treated by lateral internal sphincterotomy, which reduces muscle spasms and pain. If other severe conditions are suspected, a referral to a specialist for further investigations is required.

What Are the Risk Factors?

A few common risk factors

  • Constipation: The danger of ripping is increased when straining occurs during bowel movements and when passing firm stools.

  • Giving Birth: After giving delivery, women are more likely to develop anal fissures.

  • Crohn’s Disease: An ongoing digestive system inflammation is brought on by this inflammatory bowel disease. This might increase the anal canal's lining's susceptibility to tears.

  • Anal intercourse.

  • Age: Although they can happen at any age, anal fissures are more prevalent in young children and middle-aged adults.

Less frequently occurring risk factors for the formation of anal fissures include:

  • Infants and kids.

  • Senior citizens.

  • HIV.

What Are the Complications of Anal Fissures?

  1. Chronic Anal Fissure: If the anal fissure does not respond to treatment in eight weeks, it is considered a chronic anal fissure, which might require further treatment.

  2. Recurrence: Recurrence of anal fissures is common.

  3. Tear Extending to Surrounding Muscles: In some cases, an anal fissure may extend and reach the internal anal sphincter muscle, a ring of muscle responsible for keeping the anus closed. This makes the healing of anal fissures difficult and causes discomfort.

What Lifestyle Changes Help in Treating Anal Fissures?

  1. An anal fissure can be healed by keeping the stools soft by daily taking around 25 to 30 grams of fiber. Whole grains, fruits, vegetables, and nuts are fiber-rich foods. Fiber supplements can be taken if required, but it should be noted that fiber should be taken gradually, as it can produce abdominal bloating and gas problems.

  2. Constipation can be prevented by drinking adequate amounts of water.

  3. During bowel movements, strain should be avoided because it creates pressure that might cause a new tear or open up an already-healed one.

  4. In children with anal fissures, frequently changing the diapers and washing the area gently help promote healing.

How Can Anal Fissure Be Prevented?

Chronic constipation is a common cause of anal fissures. Among the recommendations are:

  • Have a diet rich in fiber.

  • Water consumption can aid in the softening of feces.

  • Take into consideration applying a fiber supplement (like Metamucil).

  • After using the loo, be sure to wipe gently.


Patients' quality of life may be significantly impacted negatively by anal fissures. First, consider conservative management, which includes analgesia and stool softener. Glyceryl trinitrate is a useful medication; however, some patients may experience ineffective treatment due to its adverse reactions and recurrence rate. As substitutes, Nifedipine and topical Diltiazem may be attempted. Referrals to secondary care are encouraged if, after eight weeks, medical care is not beneficial. Referrals should be made as soon as possible if it appears that an anal fissure is a secondary symptom of a significant underlying ailment.

Frequently Asked Questions


How Long Do Anal Fissures Last?

Usually, anal fissures heal within a few weeks without treatment. But they can recur and come back when they are caused by constipation that remains untreated. In chronic anal fissures, symptoms last for six weeks or more.


Can a Fissure Heal on Its Own?

In the case of acute anal fissures, they do not last longer than six weeks. They are common and usually heal on their own with self-care. Anal fissures that last longer than six weeks are called chronic anal fissures, and they may need surgery or medicine to help them heal.


Which Ointment Is Best for Fissures?

Nitroglycerin ointment is the most effective medicine for relaxing blood vessels and the anal sphincter and treating anal fissures. This ointment needs to be compounded by a compounding pharmacy.


What Is the Home Remedy for Anal Swelling?

The home remedies for anal swelling are,
- Warm baths that cover the legs help to reduce irritation and ease the swelling caused by hemorrhoids.
- Coconut oil helps to reduce the urge to scratch.
- Aloe vera helps with itching, swelling, and burning when applied to the anus.
- Applying ice packs may relieve pain and inflammation.
- Over-the-counter medications such as Acetaminophen or Ibuprofen may help.


Is Vaseline Good for Anal Fissures?

Vaseline or petroleum jelly is good for anal fissures as it helps to lubricate the anorectal area. In addition, soaking in a warm bath for 10 to 20 minutes several times a day, avoiding strained toilet or prolonged sitting on the toilet, and gently cleansing the anorectal area helps to relax the anal muscles.


Which Exercise Is Best for Anal Fissure?

Engaging in 30 minutes of moderate physical activity, such as walking and exercising most days of the week, helps with anal fissures. Exercise regulars the bowel movements and increases the blood flow to most parts of your body, so it promotes the healing of an anal fissure.


Does Sitting Add Benefits for Anal Fissures?

Regular sitting bath, that is, sitting in warm water up to the hips, helps to relax the anal sphincter. Sitting can be painful for people with anal fissures, and also they should not strain during bowel movements.


What Foods Are Good for Anal Fissure?

Most anal fissures heal by following good elimination habits, taking plenty of water and fiber, and avoiding constipation foods and popcorns, tortilla chips, or nuts.


What Is the Difference between a Fissure and a Hemorrhoid?

The difference is that they are each a different kind of injury, where anal fissure is a tear of tissue, hemorrhoids occur due to the weakening of cushions of tissue in the lower rectum. This causes the skin to swell up like a tiny balloon and fill with blood.


Is Hydrocortisone Good for Fissures?

Hydrocortisone is used to treat itching, minor pain, discomfort, and swelling caused by hemorrhoids and other problems of the anal area, such as itching, anal fissures, etc.
Dr. Mahmoud Ahmed Abdelrahman Abouibrahim
Dr. Mahmoud Ahmed Abdelrahman Abouibrahim

Internal Medicine


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