What is anal fissure?

An anal fissure is a tear in the lining of the lower rectum (anus). It can itch and cause pain. You may notice bright red blood on toilet paper after you wipe. A fissure may form if you're constipated and try to pass a large, hard stool or if you don't relax your anal muscles during a bowel movement.

Most anal fissures heal with home treatment after a few days or weeks. If you have an anal fissure that takes more time to heal, your doctor may prescribe medicine. In rare cases, surgery may be needed.

Anal fissures don't lead to colon cancer or other serious illnesses. But if you have blood mixed in with the stool, talk to your doctor.

Symptoms may include a sharp, stinging, or burning pain during a bowel movement. The pain can be severe and may last a few hours. You may also notice spots of bright red blood on toilet tissue. This blood is separate from the stool. Some fissures may bleed but cause no other symptoms.

Most anal fissures heal in a few days or weeks with home treatment. But if a fissure lasts more than 8 to 12 weeks, you may need prescription medicines. These may include cream or gel vasodilator medicines or botulinum toxin (Botox) injections.

In rare cases, surgery may be needed. The most common surgery is called a lateral internal sphincterotomy. In this procedure, a doctor cuts into part of the internal sphincter to relax the spasm that is causing the fissure.

A doctor can diagnose an anal fissure based on your symptoms and a physical exam. The exam may include:

• Looking at the fissure by gently separating the buttocks.
• A digital rectal exam. The doctor inserts a gloved finger into the anal canal.
• Anoscopy. This involves using a short, lighted scope to look into the anal canal.

The doctor may wait until the fissure has started to heal before doing a rectal exam or anoscopy. If an exam needs to be done right away, medicine can be used to numb the area.

During an exam, a doctor can also find out whether another condition may be causing the fissure. Having several fissures or having one or more in an area of the anus where fissures usually don't occur can be a sign of a more serious problem, such as inflammatory bowel disease or a weakened immune system.

Most short-term anal fissures can heal with home treatment in 4 to 6 weeks. Pain during bowel movements usually goes away within a couple of days after the start of home treatment.

There are several steps you can take to relieve your symptoms and help the fissure heal:

• Try to prevent constipation. For example:
  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
  • Drink plenty of fluids.
  • Get some exercise every day.
  • Take a fiber supplement, such as Benefiber or Metamucil, every day if needed. Read and follow all instructions on the label.
  • Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. Take your time and do not strain when having a bowel movement. But do not sit on the toilet for more than 10 minutes.
• Try taking stool softeners or laxatives to make bowel movements less painful. Ask your doctor how long you should take laxatives.
• Sit in a tub filled with a few inches of warm water for 20 minutes, 2 or 3 times a day. This is called a sitz bath. It soothes the torn tissue and helps relax the internal anal sphincter. Do not put soaps, salts, or shampoos in the water.
• Talk with your doctor about whether to try a nonprescription cream such as zinc oxide, Preparation H, Anusol, or 1% hydrocortisone for a short time. These may help soothe anal tissues.
• Be safe with medicines. Read and follow all instructions on the label. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Instead of using toilet paper, use baby wipes or medicated pads, such as Tucks pads or Preparation H wipes, to clean after a bowel movement.

Don't avoid having bowel movements. Knowing that it might hurt may make you anxious. But trying not to have bowel movements will only make constipation worse and keep the fissure open and painful.

Anal fissures are caused by injury or trauma to the anal canal. Injury can happen when:

• You pass a large stool.
• You are constipated and try to pass a hard stool.
• You have repeated diarrhea.
• You give birth. (Childbirth can cause trauma to the anal canal.)

Fissures can also be caused by a rectal exam, anal intercourse, or a foreign object. In some cases, a fissure may be caused by a health problem, such as Crohn's disease.

Many experts believe that extra tension in the two muscular rings (sphincters) controlling the anus may be a cause of fissures.

An anal fissure is a tear in the lining of the lower rectum (anal canal) that causes pain during bowel movements. Anal fissures are common, and they affect people of all ages. They don't lead to more serious problems. Most anal fissures will heal with home treatment.