Anal Fissure
An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).
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 increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.
Symptoms
Signs and symptoms of an anal fissure include:
Causes
Common causes of anal fissure include:
- Passing large or hard stools
- Constipation and straining during bowel movements
- Chronic diarrhea
- Anal intercourse
- Childbirth
Less common causes of anal fissures include:
Risk Factors
- Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.
- Childbirth. Anal fissures are more common in women after they give birth.
- Anal intercourse.
- Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.
Complications
Complications of anal fissure can include:
- Failure to heal. An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
- Recurrence. Once you've experienced an anal fissure, you are prone to having another one.
- A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.
Prevention
Diagnosis
Your doctor will likely ask about your medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually this exam is all that’s needed to diagnose an anal fissure.
An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear, and may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.
The fissure’s location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn’s disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition:
- Anoscopy. An anoscope is a tubular device inserted into the anus to help your doctor visualize the rectum and anus.
- Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.
- Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.
Doctors & Hospitals
Recommended Hospitals
Narayana Superspeciality Hospital, Gurgaon
UPHI-The Wellness & Surgical Centre, Gurgaon
Max Super Specialty Hospital, Gurgaon
You may be able to prevent an anal fissure by taking measures to prevent constipation or diarrhea. Eat high-fiber foods, drink fluids and exercise regularly to keep from having to strain during bowel movements.
- Pain, sometimes severe, 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
An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear, and may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.
The fissure’s location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn’s disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition:
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