• Español

Anal Fissure

Topic Overview

What is an anal fissure?

An anal fissure is a tear in the lining of the lower rectum (anal canal) that causes pain during bowel movements. Anal fissures don't lead to more serious problems.

Most anal fissures heal with home treatment after a few days or weeks. These are called short-term (acute) anal fissures. If you have an anal fissure that hasn't healed after 8 to 12 weeks, it is considered a long-term (chronic) fissure. A chronic fissure may need medical treatment.

Anal fissures are a common problem. They affect people of all ages, especially young and otherwise healthy people.

What causes an anal fissure?

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 Crohn's disease.

Many experts believe that extra tension in the two muscular rings (sphincters) controlling the anus may be a cause of fissures. The outer anal sphincter is under your conscious control. But the inner sphincter is not. This muscle is under pressure, or tension, all of the time. If the pressure increases too much, it can cause spasm and reduce blood flow to the anus, leading to a fissure. This pressure can also keep a fissure from healing.

What are the symptoms?

You may have:

  • A sharp, stinging, or burning pain during bowel movements. Pain from a fissure may be quite severe. It can be brief or last for several hours after a bowel movement.
  • Itching.
  • Bleeding. You may see a small spot of bright red blood on toilet tissue or a few drops in the toilet bowl. The blood from a fissure is separate from the stool. (Very dark, tarry stools or dark red blood mixed with stool may be a sign of a more serious problem.) Tell your doctor if you have any bleeding with a bowel movement.

Sometimes an anal fissure may be a painless wound that won't heal. It may bleed from time to time but cause no other symptoms.

How is an anal fissure diagnosed?

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.

How is it treated?

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 Citrucel or Metamucil, every day if needed. Start with a small dose. Then very slowly increase the dose.
    • Schedule time each day for a bowel movement. Take your time. Don't strain.
  • 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.
  • 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. But fiber and sitz baths help symptoms more.1
  • Instead of using toilet paper, use baby wipes or medicated pads, such as Tucks, 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.

What happens if the fissure doesn't heal on its own?

About 9 out of 10 short-term fissures heal with home treatment—including using stool softeners or fiber supplements and taking regular sitz baths. And about 4 out of 10 long-term anal fissures will heal after home treatment is used.1

But not all fissures will heal with just home treatment. If a fissure lasts more than 8 to 12 weeks, you may need prescription medicines. These may include nitroglycerin cream, high blood pressure medicines in pill or gel form, or injections of botulinum toxin (Botox).

If medicines don't stop your symptoms, you may need to consider surgery. The most commonly used surgery is lateral internal sphincterotomy. In this procedure, a doctor cuts into part of the internal sphincter to relax the spasm that is causing the fissure.

Other Places To Get Help

Organizations

American College of Gastroenterology
6400 Goldsboro Road
Suite 200
Bethesda, MD 20817
Phone: (301) 263-9000
Web Address: http://patients.gi.org
 

The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.


American Gastroenterological Association
4930 Del Ray Avenue
Bethesda, MD  20814
Phone: (301) 654-2055
Fax: (301) 654-5920
Web Address: www.gastro.org
 

The American Gastroenterological Association is a society of doctors who specialize in the digestive system (gastroenterologists). This Web site can help you find a gastroenterologist in your area. They also have patient information on many gastrointestinal diseases and disorders.


American Society of Colon and Rectal Surgeons
85 West Algonquin Road
Suite 550
Arlington Heights, IL  60005
Phone: (847) 290-9184
Fax: (847) 290-9203
Email: ascrs@fascrs.org
Web Address: www.fascrs.org
 

The American Society of Colon and Rectal Surgeons is the leading professional society representing more than 1,000 board-certified colon and rectal surgeons and other surgeons dedicated to treating people with diseases and disorders affecting the colon, rectum, and anus.


National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD  20892-3570
Phone: 1-800-891-5389
Fax: (703) 738-4929
TDD: 1-866-569-1162toll-free
Email: nddic@info.niddk.nih.gov
Web Address: www.digestive.niddk.nih.gov
 

This clearinghouse is a service of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the U.S. National Institutes of Health. The clearinghouse answers questions; develops, reviews, and sends out publications; and coordinates information resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.


References

Citations

  1. Dozois EJ, Pemberton JH (2006). Anal fissure section of Hemorrhoids and other anorectal disorders. In MM Wolfe et al., eds., Therapy of Digestive Disorders, pp. 948–950. Philadelphia: Elsevier.

Other Works Consulted

  • Madoff RD, Fleshman JW (2003). American Gastroenterological Association Medical position statement: Diagnosis and care of patients with anal fissure. Gastroenterology, 124(1): 233–234.
  • Marcello PW (2010). Diseases of the anorectum. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 2257–2267. Philadelphia: Saunders.
  • Nelson RL (2011). Operative procedures for fissure in ano. Cochrane Database of Systematic Reviews (11).
  • Perry W, et al. (2010). Practice parameters for the management of anal fissures (3rd revision). Diseases of the Colon and Rectum, 53(8): 1110–1115.
  • Welton ML, et al. (2010). Anal fissure and ulcer section of Anorectum. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery. 13th ed., pp. 710–712. New York: McGraw-Hill.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer C. Dale Mercer, MD, FRCSC, FACS - General Surgery
Last Revised May 15, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2013 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.


The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.