An anal fissure is a small incision or tears in the lining of the anus. Cracks in the skin can cause severe pain and some bright red bleeding during and after a bowel movement. Sometimes the cracks are deep enough to expose the muscle tissue underneath.

Anal fissures are not usually a serious condition. It affects people of all ages and constipation is a common problem in this age group, which is why it is often seen in infants and young children.


In most cases, the tear will heal on its own in four to six weeks. In cases where the tear is longer than eight weeks, it is considered chronic.

Some treatments promote healing and help eliminate discomfort, including softening of the stool and topical pain relief.

If the anal fissure does not improve with these treatments, you may need surgery. Or your doctor may need to look for other underlying conditions that can cause anal fissures.

What are the symptoms of an anal fissure?

Anal fissures can cause one or more of the following symptoms:

  • A tear that appears in the skin around your anus.

  • A skin tag next to the tear or small bump of skin

  • Sharp pain in the anal area during defecation.

  • Bloodstains on tables or toilet paper after cleaning

  • Burning or itching in the anal area

What Causes Anal Fissures?

Anal fissures most often occur when crossing large or rough ridges. Chronic constipation or frequent diarrhea has also torn the skin around the anus. Other common causes:


  • Leaking during labor or bowel movements

  • Inflammatory bowel disease (IBD) such as Crohn’s disease

  • Decreased blood flow to the anorectal area.

  • Overly tense or spastic anal sphincter muscles


In rare cases, this can cause anal fissures:

  • Anal cancer

  • HIV

  • Tuberculosis

  • Syphilis

  • Herpes

Who is at risk for anal fissures?

Anal fissures are common in childhood. Older people also suffer from anal fissures due to reduced blood flow to the anorectal area. During and after childbirth, women experience anal leakage fissures during childbirth.

People with IBD are also at risk for anal fissures. The inflammation that occurs in the intestinal lining is likely to tear the tissue around the anus.


People who experience frequent constipation are also at increased risk of anal fissures. Filtering and crossing of large, rough tops are the most common causes of anal fissures.

How is an anal fissure diagnosed?

The doctor can usually diagnose anal fissures by examining the area around the anus. However, they may want to have a stool test to confirm the diagnosis.

During this test, the doctor may insert an anoscope into the rectum to make the tears easier to see. This medical device is a thin tube that allows doctors to examine the anal canal.

Using an anoscope can help your doctor find other causes of anal or rectal pain. In some cases of rectal pain, you may need an endoscopy for a better evaluation of your symptoms.

How is anal fissure treated?

Most anal fissures do not require extensive treatment. However, some home remedies can help promote healing and eliminate uncomfortable symptoms. 

You can treat anal fissures at home:


  • Using over-the-counter stool softeners

  • Drink more fluids

  • Take fiber supplements and eat more fiber like raw fruits and vegetables

  • Sitz bath to relax anal muscles, relieve irritation, and increase blood flow to the anorectal area.

  • Hydrocortisone cream, such as a nitroglycerin or cortisone 10 ointment, can help with inflammation to promote blood flow to the area.

  • Apply topical pain relievers such as lidocaine to the anus to reduce discomfort.

If your symptoms don’t go away within two weeks of treatment, see your doctor for further evaluation. Your doctor can make sure you have a proper diagnosis and recommend other treatments.


Calcium channel blocking ointment allows the sphincter muscles to relax and heal anal fissures.

Another treatment is Botox injections into the anal sphincter. Injections can prevent cramps in the anus by temporarily freezing the muscle. This allows the anal fissure to heal while preventing new fractures from forming.


If your anal fissure does not respond to other treatments, your doctor may recommend an anal sphincterotomy. This surgical procedure involves making a small incision in the anal sphincter to relax the muscles. Relaxing the muscle heals the anal fissure.


Not all anal fissures are a sign of a low fiber diet and constipation. Fractures that don’t heal well or conditions other than the posterior and midline of the anus may indicate an underlying condition.


If you have a problem with cracks that have not healed despite home remedies, see your doctor if you need further testing.

How to prevent anal fissures?

Anal fractures can’t always be prevented, but you can reduce your risk of getting one by taking the following preventive measures:


  • Keeping the anal area dry

  • Clean anal area with mild soap and warm water.

  • Drink plenty of fluids, eat plenty of fiber, and exercise regularly to prevent constipation.

  • Immediate treatment for diarrhea.

  • Change baby diapers frequently

Takeaway

Anal fissures cause sharp pain when defecating and small amounts of bright red blood. If it develops into a chronic anal fissure, skin tags may develop in the area associated with the chronic local infection.

Previous anal surgeries, inflammatory bowel disease, local cancers, and sexually transmitted diseases are conditions associated with anal fissures.

 

Some conditions that can lead to more direct anal fissures include injuries to areas such as vaginal delivery, anal sex, or hard stools.