What is an anal fissure?
An anal fissure is a tear in the lining of the anus or anal canal
(the opening through which stool passes out of the body). The
fissure can be painful and may bleed.
What are the signs and symptoms of an anal fissure?
Signs and symptoms include:
- Pain during, and even hours after, a bowel movement
- Constipation
- Blood on the outside surface of the stool
- Blood on toilet tissue or wipes
- A visible crack or tear in the anus or anal canal
- Burning and itch that may be painful
- Discomfort when urinating, frequent urination, or inability to
urinate
- Foul-smelling discharge
How is an anal fissure diagnosed?
Usually your doctor can diagnose an anal fissure by visual
inspection of the anus or by gentle exam with the tip of the
finger.
What causes an anal fissure?
Anal fissures can be caused by trauma to the anus and anal canal.
The cause of the trauma can be one or more of the
following:
- Chronic constipation
- Straining to have a bowel movement, especially if the stool is
large, hard, and/or dry
- Prolonged diarrhea
- Anal sex, anal stretching
- Insertion of foreign objects into the anus
Other causes of anal fissures (other than trauma) include:
- Longstanding poor bowel habits
- Overly tight or spastic anal sphincter muscles (muscles that
control the closing of the anus)
- Scarring in the anorectal area
- Presence of an underlying medical problem: such as
Crohn's disease and ulcerative colitis [types of inflammatory
bowel disease]; anal cancer; leukemia; infectious diseases (such as
tuberculosis); and sexually transmitted diseases (such as syphilis,
gonorrhea, Chlamydia, chancroid, HIV)
- Decreased blood flow to the anorectal area
Anal fissures are also common in women after childbirth and in
young infants.
Who is at risk for the development of anal
fissures?
Anal fissures can occur in anyone at any age. Generally, the chance
of an anal fissure occurring decreases as age increases. However,
people who have had fissures in the past are more likely to have
them in the future.
How are anal fissures treated?
The goal of treatment is to lower the pressure on the anal canal by
making stools soft as well as easing discomfort and bleeding.
Conservative treatments are tried first and include one or more of
the following:
- Preventing constipation through the use of stool softeners,
increased intake of fluids while avoiding caffeine-containing
products (which cause dehydration), and dietary adjustments
(increase in intake of high fiber foods and fiber supplements)
- Soaking in a warm bath (also called a sitz bath), 10 to 20
minutes several times a day, to promote the relaxation of the anal
muscles
- Cleansing the anorectal area more gently
- Avoiding straining or prolonged sitting on the toilet
- Using petroleum jelly to help lubricate the anorectal area