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Anal Fissure


Disease: Anal Fissure Anal Fissure
Category: Digestive diseases
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Disease Definition:

A small tear in the lining of the anal canal is called an anal fissure, which may develop in adults from passing hard or large stools during bowel movements. It’s quite common in infants between 6 and 24 months, but it is less likely to happen in older children.

Pain and bleeding may be caused by an anal fissure, and if it doesn’t heal, it may become chronic and cause considerable discomfort, in which case the patient might consider surgery. However, more than 90% of the people with anal fissure heal without surgery. In order to provide relief as the anal fissure heals, a person may use topical creams or suppositories.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Some of the major signs and symptoms of an anal fissure are:


  • A visible crack in the skin around the anus
  • Itching or irritation around the anus
  • Pain or burning during bowel movements that eases until the next bowel movement.
  • Bright red blood on the outside of the stool or on toilet paper or wipes after a bowel movement.

In case a person notices blood on stools or toilet paper after a bowel movement or experiences pain during bowel movements, then they should see a doctor.


Anal fissure may be caused by:


  • Inflammation of the anorectal area, which may be caused by inflammatory bowel disease (IBD)
  • Large or hard stool passing through the anal canal
  • Constipation and straining during bowel movements
  • Anal sex in less common cases



If a fissure doesn’t heal in six weeks, then it becomes chronic. This injury rarely causes any complications, but once it occurs, it may happen again, leading to repeated injury of the tissue.

Another type of complication is that the tear may go into the internal anal sphincter, which is a ring of muscle that holds the anus closed except during bowel movements. Now, when a tear occurs in this muscle, it usually causes it to spasm, which widens the tear and hampers healing.
A person with this condition may need to have surgery to reduce the pain and repair or remove the fissure if the fissure is hasn’t healed or if it is causing a cycle of discomfort.


The signs and symptoms of an anal fissure may go away within two weeks, and it may require nonsurgical treatments or sometimes no treatment at all. But in case it doesn’t heal in six to eight weeks, surgery may be needed.
The doctor should be consulted if a person wants to find ways to avoid constipation and ensure regular bowel movements to prevent their baby from straining. In any case, the only intervention may be changing the diaper regularly and keeping the anal area clean.
In case lifestyle and self-care measures aren’t effective, such as drinking more water, adding more fiber to the diet, getting regular exercise and taking a stool softener or occasional laxative, someone with anal fissure may be recommended these nonsurgical treatments:

Medical creams or suppositories:
In order to help reduce inflammation and ease discomfort, over-the-counter creams or ointments can be used containing hydrocortisone or a person may be prescribed a rectal corticosteroid.

Other nonsurgical therapies:
Some doctors may recommend small doses of nitroglycerine ointment, to avoid dangerous side effects. When this ointment is applied to the anus, it widens blood vessels and increases blood flow to the tear, which promotes its healing. This type of therapy also helps in reducing the pressure in the anal sphincter, which eases the spasm and decreases pain, both of which promote healing. In order to reduce the amount of this ointment on the skin even further, the person should wash his/her hands thoroughly after applying it.

Some of the side effects may include headaches, dizziness and low blood pressure. Men shouldn’t use this ointment within 24 hours of taking erectile dysfunction medications such as tadalafil , sildenafil , and vardenafil because of the possibility of significantly lowered blood pressure.

To avoid the side effects mentioned above, a person with anal fissure may also be advised to remain seated or lying down and to avoid exercise immediately after applying nitroglycerin.

botulinum toxin:
Injecting a small dose of botulinum toxin type A  into the internal anal sphincter is another treatment, which is fairly new. The spasm will relax because Botox paralyzes the muscle for up to three months. Anal incontinence, a temporary mild leakage of gas or stool may be a possible side effect.

Blood pressure medications:
Another possible treatment is blood pressure medications diltiazem  and nifedipine , either taken orally or ground into a gel and applied to the tear.

Surgery may be recommended if the anal fissure doesn’t heal on its own. Surgery is usually done on an outpatient basis. It may include removal of the fissure and any scar tissue resulting from it, or cutting a portion of the anal sphincter muscle to reduce spasm and pain and promote healing.
In some rare cases, cutting the anal sphincter results in loss of the ability to control bowel movements.


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