Anal Fissures

An anal fissure is a tear in the lining of the lower rectum (anus) that causes pain when going to the bathroom (bowel movement). It is a common condition that is not serious. Most anal fissures heal with home treatment after a few days or weeks (acute). If a fissure does not heal after 6 weeks it is considered a long-term problem (chronic).

Causes

Fissures affect people of all ages. In adults, fissures may be caused by constipation, the passing of large, hard stools, by prolonged diarrhea, or a decreased blood flow to the anal area. Anal fissures are also common in women after childbirth and persons who have Crohn’s disease. In infants, anal fissures are common, and less common among school-aged children.

Symptoms

Anal fissures may cause a sharp, stinging, or burning pain during a bowel movement. The pain can be severe and last several hours. Fissures my itch and often bleed. Blood may be seen on the toilet tissue, in the toilet bowl, or on the stool. Very dark, tarry stools or dark red blood mixed with the stool may be from some other condition like inflammatory bowel disease (IBD) or colon cancer and should be seen by a doctor.

Diagnosis

Usually a doctor can see the fissure with a gentle exam of the anus. A lighted instrument (anoscope) may also be used to examine the fissure. During the exam, the doctor can check to see if there is another condition causing the fissure. If there is rectal bleeding, a sigmoidscopy/colonoscopy could be done to determine the problem.

Treatment

Most fissures can be treated at home. Some of the treatment includes:

  • Soaking in a tub of warm water 2-3 times a day.
  • Increasing fiber in the diet.
  • Taking stool softeners or laxatives
  • Drinking plenty of water or other fluids to help make stool softer and easier to pass.
  • Nonprescription ointments such as zinc oxide, Preparation H, Anusol or 1% hydrocortisone.
  • Muscle relaxants applied to the skin.
  • Petroleum jelly applied to the area.
  • Regularly change diapers in infants.

If the fissure lasts a long time, prescription medicine like nitroglycerin, high blood pressure medicines, and botulinum toxin (Botox) may be necessary to relax the internal muscles in and anus. If medicines do not help, common surgery, a later internal sphincterotomy, may be needed to relax the internal sphincter.