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An anal fissure is a small tear in the thin, moist tissue that lines the anus. The anus is the opening at the end of the digestive tract where stool exits the body. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus, called the anal sphincter.
Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as eating more fiber or soaking in a warm-water bath. Some people with anal fissures may need medicine. Sometimes, surgery may be necessary.
Symptoms of an anal fissure include:
See a healthcare professional if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.
Common causes of anal fissures include:
Less common causes of anal fissures include:
Factors that may increase the risk of developing an anal fissure include:
Complications of an anal fissure may include:
You may be able to prevent an anal fissure by taking measures to prevent constipation or diarrhea. Eat high-fiber foods, drink fluids, and exercise regularly to keep from having to strain during bowel movements.
A healthcare professional will likely ask about medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually, this exam is all that's needed to diagnose an anal fissure.
A more recent, acute anal fissure looks like a fresh tear, somewhat like a paper cut. A long-lasting, also called chronic, anal fissure likely has a deeper tear. It also may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.
The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a symptom of another condition, such as Crohn's disease. A medical professional may recommend further testing to find out if there is an underlying condition. Tests may include:
Anal fissures often heal within a few weeks with appropriate home treatment. Take steps to keep the stool soft, such as increasing your intake of fiber and fluids. Soak in warm water for 10 to 20 minutes several times a day, especially after bowel movements. This can help relax the sphincter and promote healing. If symptoms persist, you'll likely need further treatment.
A healthcare professional may recommend the following:
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, surgery may be recommended. Surgeons usually perform a procedure called lateral internal sphincterotomy (LIS). LIS involves cutting a small part of the anal sphincter muscle. This technique may help promote healing and reduce spasm and pain.
Studies show that surgery is much more effective than any medical treatment for chronic fissure. However, surgery has a small risk of causing incontinence.
Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent one from coming back. Changes include:
If your infant has an anal fissure, change diapers often and wash the area gently. Also, be sure to discuss the problem with your child's healthcare team.
If you have an anal fissure, you may be referred to a doctor who specializes in digestive diseases, called a gastroenterologist, or a colon and rectal surgeon.
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Before your appointment:
Some basic questions to ask include:
Don't hesitate to ask other questions during your appointment.
You may be asked:
While you're waiting to see your healthcare professional, take steps to avoid constipation, such as:
Also, don't strain during bowel movements. The extra pressure may lengthen the fissure or create a new one.