Anal fissures are tears, or cracks, in your anus. Fissures are sometimes confused with hemorrhoids, which are inflamed blood vessels in, or just outside, the anus. Both fissures and hemorrhoids often result from passing hard stool.
More about anal fissures
What causes anal fissures?
Fissures result from the stretching of your anal mucosa beyond its normal capacity. This often happens when stools are hard due to constipation. Once the tear happens, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. The spasm also pulls the edges of the fissure apart, making it difficult for your wound to heal. The spasm then leads to further tearing of the mucosa when you have bowel movements. This cycle leads to the development of a chronic anal fissure in patients.
What are some symptoms of anal fissures?
- Pain during and after a bowel movement
- Visible tear or cut in the area
- Bright red bleeding during or after a bowel movement
What are some risk factors that may cause anal fissures?
Certain factors raise the risk for anal fissures, including:
- Constipation with straining to pass hard stool
- Eating a low-fiber diet
- Intense diarrhea
- Vaginal childbirth
- Any inflammatory condition of the anal area
How are anal fissures diagnosed?
Your healthcare provider will make a diagnosis based on:
- Your personal health history
- Your description of symptoms
- Rectal exam
Because other conditions can cause symptoms similar to an anal fissure, your healthcare provider might also order tests to find out whether there is blood in your stool.
What treatments are available for anal fissures?
An acute anal fissure typically heals within 6 weeks with conservative treatment. Some disappear when constipation is treated. Anal fissures that last for 6 weeks or more are called chronic anal fissures. These fail conservative treatment and need a more aggressive, surgical approach.
People whose anal fissures don’t heal well may have an imbalance in anal pressure that prevents blood from circulating normally through the blood vessels around the anus. The reduced blood flow prevents healing. Medicine, Botox injections, and even some topical treatments that improve blood flow, may help anal fissures heal.
Other treatments include:
- Having surgery, such as a lateral internal sphincterectomy. During the surgery, the pressure inside the anus is released. This allows more blood to flow through the area to heal and protect tissues.
- Changing your diet to increase fiber and water, steps that will help regulate your bowel movements and reduce both diarrhea and constipation
- Taking stool softeners, such as fiber supplements, as needed
- Using topical medicines, such as nitrates or calcium blockers
- Taking warm baths for up to 20 minutes a day
How to live with anal fissures?
If you have an anal fissure, take these precautions to avoid making it worse and avoid recurrences:
- Take all medicines as prescribed.
- Get the recommended amount of fiber in your diet. Avoid constipation or large or hard bowel movements.
- Drink enough water to stay well hydrated.
- Maintain a routine bowel habit. Ask your healthcare provider about what this should be for you.
- Avoid spicy foods while you have an anal fissure, because they may make symptoms worse.
Review Date: March 2024
