An anal fissure is a small tear or open sore in the anus. It can cause pain and bleeding when you pass a bowel movement, especially if you are constipated.
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
Anal fissures are caused by an injury that stretches or tears the anus. To help protect the anus from further damage, the muscle around the anus, known as the anal sphincter, tightens. This leads to further pain and impaired healing.
The causes for an anal fissure include:
In some circumstances the fissure is caused by very tight anal sphincter muscles. You have two sphincters in your anus: the outer one, which you control, and the inner one, which you do not consciously control. The inner sphincter is under constant pressure, keeping waste inside. In some people the tension in this muscle is very high, reducing blood flow to the area and causing more spasms. This tension is considered to delay healing and can be addressed with medications or, in some cases, surgery.
A ring of muscle that controls the opening and closing of the anus.
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
A group of conditions characterized by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.
Sexual intercourse that involves penetration of the anus with the penis.
The main risk factors for anal fissures include:
A group of conditions characterized by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.
Sexual intercourse that involves penetration of the anus with the penis.
An anal fissure usually appears in the back region of your anus. It can look like a small hole or split in the skin, it may be ulcerated. In a condition, called Crohn's disease, there may be multiple fissures with a slightly bluish skin discoloration. With any rectal bleeding and ulceration your doctor will want to rule out other causes including anal or rectal cancer, which can have similar symptoms to an anal fissure.
Anal fissure in the lining of the anus.
You may find small amounts of bright red blood in the toilet pan or on toilet tissues after you have passed a bowel movement. Your stools may be coated in blood.
You may feel a sharp tearing or burning pain, during or just after you have passed a large or dry stool. The pain can last for minutes or hours and sometimes radiate down the back of your legs. You may also find that sitting on hard surfaces causes discomfort or pain.
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
A cancer in the very lower end of the large intestine that is characterized by a change in bowel habits or passage of blood.
Your doctor will usually be able to diagnose them by visual examination only. Very gently parting your buttocks to view the anus will usually suffice. If further tests are required these can be done using local anesthetic to avoid pain. These may include:
During a digital rectal examination (DRE) your doctor may use a topical anesthetic cream to numb your anal region before putting a lubricated, gloved finger in your anus to feel for abnormalities or lumps, and;
Your doctor may wish to perform one of these tests to further investigate the fissure or cause of rectal bleeding. They will use a topical anesthetic cream to numb your anal region before beginning the examination. A tubular instrument is inserted into the anus and can be used to look at the walls of the anus (anoscope), rectum (proctoscope) and sigmoid colon (sigmoidoscope). The type of instrument will depend on how far into the bowel your doctor needs to see. These tests can usually be performed in the doctor's rooms and do not require any sedation or general anesthetic. As these instruments are quite short, areas of the large bowel beyond the sigmoid colon cannot be examined.
Your doctor may also refer you for a colonoscopy if they are concerned about potential causes further up the large bowel. This procedure is usually done in an operating theatre and you will be sedated. During a colonoscopy, the entire length of the large bowel can be examined using a long tube with a camera called a colonoscope. This test is the preferred method for excluding bowel cancer and may be used to further investigate cases of rectal bleeding or inflammatory bowel disease, such as Crohn's disease.
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
An anesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anesthetic is given in hospital by a specialist called an anesthetist.
A group of conditions characterized by chronic, episodic inflammation of the bowels, including Crohn's disease and ulcerative colitis.
A type of medication that, when administered to an area, creates a localized loss of sensation by blocking nerve activity.
The final part of the large intestine, leading to the anus.
The part of the large intestine before the rectum.
While most cases of anal fissure will heal themselves within 2-4 weeks without any treatment, the following may also be recommended:
Preventing constipation is the first form of treatment, as soft stools prevent further pain and damage, giving your rectum a chance to heal. Passing large, dry stools can stretch and reopen semi-healed fissures, causing extreme pain and preventing the fissure healing. Also, decreasing the tension in your anal sphincter will increase blood flow and aid faster healing.
Try to avoid constipation by following a high-fiber diet containing plenty of fruit, vegetables and wholegrain products and increasing your water intake. Taking a fiber supplement (available at your local pharmacist or supermarket) may also help.
Your doctor may suggest you take laxatives for a few weeks to keep your stools soft, as this will minimize pain and further damage. Your doctor may also recommend suppository laxatives, which are soft capsules that are inserted into your rectum and break down dry stools.
Using moist, unperfumed toilet paper or wipes will help keep the anal area clean and cause less irritation than dry paper. If you are in extreme pain, use warm water with cotton buds or cotton wool. It is very important to keep the fissure clean to avoid infection.
Sitting for 15 minutes after each bowel movement in a warm shallow bath or using a Sitz bath with added salt, can greatly reduce the pain associated with anal fissures. The warm water increases circulation and will relax your anal sphincter to reduce spasms and pain.
Try to avoid sitting for long periods of time and exercise as often as you can, as this will increase blood circulation to your anal region and aid healing.
Several types of creams can help, including:
You may be advised to take over-the-counter pain-relief medications, such as acetaminophen or ibuprofen, to help with pain. Avoid codeine, as it may cause constipation.
Surgery is seen as one of the most effective treatments for chronic anal fissures but like most procedures it also carries a small risk of complications.
A relatively new treatment option, when other treatments have not helped, is to inject botulinum toxin into your anal sphincter. The aim is to reduce the tension from the sphincter, which can reduce pain and allow time for the fissure to heal. The effects are supposed to last around three months. Side effects, such as potential incontinence, need to be considered and discussed with your doctor.
This procedure involves making a small cut through your anal sphincter muscle, to reduce the amount of tension present. This helps your fissure to heal and lessens the chances of developing another fissure. It will be done under general or local anesthetic but usually would not involve you having to spend the night in hospital. Recovery is normally within four weeks of surgery, with good success rates. There is a very small risk of being unable to control passing gas or stools, but this function usually returns eventually.
This procedure is only considered in chronic conditions. It involves taking healthy tissue from elsewhere in your body and using it to repair your fissure, increasing blood supply and therefore healing. This would be done under general anesthetic and you may have to stay overnight in hospital.
You may undergo surgery to gently dilate (stretch) your anal sphincter. This will be done under a local or general anesthetic and usually does not require an overnight stay in hospital. Accidental leakage of stools can be a complication of this procedure.
A ring of muscle that controls the opening and closing of the anus.
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
An anesthetic given to a person to put them to sleep while having an operation or medical procedure. Afterwards, the person regains consciousness and usually has no memory of the procedure. A general anesthetic is given in hospital by a specialist called an anesthetist.
The uncontrollable loss, small or large, of bladder or bowel control, resulting in leakage of their contents.
A type of medication that, when administered to an area, creates a localized loss of sensation by blocking nerve activity.
The final part of the large intestine, leading to the anus.
Sitz baths are special containers which can be fitted on your toilet seat. They are designed to bathe your buttocks and genitals in water, without having to get fully undressed.
A nerve toxin produced by the bacterium Clostridium botulinum, which causes muscle paralysis. It can be used cosmetically (known as Botox or by its other trade names) in low doses to relax facial wrinkles and for various medical purposes.
While most anal fissures will heal naturally, without further medical attention, the following are some potential complications you may experience:
A ring of muscle that controls the opening and closing of the anus.
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
The outlook for recovery from an anal fissure is good, as fissures are easily treated with lifestyle changes, creams, medications or surgery. They do tend to reoccur though.
Some simple things you can do to prevent getting an anal fissure include: