Anal Fissure
An anal fissure is a tear in the lining of the anus that can cause pain during or after a bowel movement and bright red bleeding. Similar symptoms have other causes, so persistent or worsening symptoms need assessment. Many fissures improve without an operation.
In this guide
Overview
An anal fissure is a small tear or crack in the lining of the anus, which can cause pain, bleeding, and discomfort during bowel movements. Here are some important points to understand about anal fissures.
Causes
- Straining during Bowel Movements: Hard stools, constipation, or diarrhea can strain the anus and lead to the development of a fissure.
- Trauma: Injuries to the anal area, such as during childbirth or anal intercourse, can cause a fissure to form.
Symptoms
- Pain: Anal fissures typically cause sharp pain and burning during or after bowel movements, which may last for hours.
- Bleeding: Bright red blood on the toilet paper or in the toilet bowl after bowel movements is a common symptom of anal fissures.
Diagnosis
- Physical Examination: A healthcare provider can diagnose an anal fissure by performing a physical examination of the anal area.
- Anoscopy or Proctoscopy: These procedures involve using a lighted instrument to visually inspect the inside of the anus and rectum for fissures.
Treatment
- Dietary Changes: Increasing fiber intake, drinking plenty of water, and following a balanced diet can help soften stools and reduce strain during bowel movements.
- Topical Medications: Over-the-counter or prescription creams (such as nitroglycerin or calcium channel blockers) may be recommended to help relax the sphincter muscles and promote healing.
- Sitz Baths: Soaking the anal area in warm water (sitz baths) several times a day can help soothe discomfort and promote healing.
- Botox Injections: In some cases, Botox injections may be used to relax the anal sphincter muscles and improve blood flow to the area, aiding in healing.
- Surgery: If conservative treatments are ineffective, surgical options such as lateral internal sphincterotomy (cutting a small portion of the internal sphincter muscle) may be considered for chronic or severe fissures.
Prevention
- Maintain Good Bowel Habits: Preventing constipation and straining during bowel movements by eating a high-fiber diet, staying hydrated, and establishing regular bowel habits can help prevent anal fissures.
- Practice Good Anal Hygiene: Keeping the anal area clean and dry can reduce the risk of irritation and infection, which may worsen fissures.
In conclusion, anal fissures are a common condition that can cause discomfort and bleeding. Most anal fissures can be effectively treated with conservative measures, but persistent or severe cases may require medical intervention. Seeking medical advice for proper diagnosis and treatment is important for individuals experiencing symptoms of an anal fissure.
A little more clarity
Your questions, answered
Is an anal fissure the same as piles or a fistula?
No. A fissure is a tear in the anal lining, piles involve swollen blood vessels and a fistula is a tunnel between the bowel and nearby skin. Symptoms can overlap, so an examination may be needed to distinguish them.
Can an anal fissure happen without constipation?
Yes. Constipation and hard stools are common factors, but frequent diarrhoea, childbirth and conditions such as Crohn's disease can also be associated with fissures. Sometimes there is no clear cause. Repeated or non-healing fissures deserve review rather than an assumption about bowel habits.
What if an examination is too painful?
Tell the clinician about your pain before the examination and discuss what you are comfortable with. A visual assessment may help, and a specialist examination under anaesthetic may be considered if pain prevents assessment or the diagnosis is uncertain. Not everyone needs an internal instrument examination.
What treatments may be tried before a procedure?
A clinician may recommend measures to keep stools soft, treatment for constipation if present and a prescribed cream to help healing. The choice depends on your symptoms and other health conditions. Ask how to use any prescribed treatment and when it should be reviewed; do not start or change prescription medicines from website advice.
When should a fissure be reassessed?
See a GP if symptoms are worsening or not improving with initial care. Persistent or recurrent pain or bleeding may need the diagnosis and treatment plan reviewed, and sometimes specialist assessment. Heavy or continuous rectal bleeding needs urgent help rather than being assumed to come from a fissure.
Sources & further reading
This guide provides general information, not an individual diagnosis or treatment plan. Your clinical team will advise what is appropriate for you.