What Is an Anal Fissure?

The anus is the opening in the bottom where stool passes out of the body. When the skin in the anus develops a tear or a crack, it is called an anal fissure.

Anal fissures may cause both bleeding and pain. The bleeding may be bright red and appear in the toilet or on toilet paper after wiping. Fissures can cause pain during and after a bowel movement that ranges from mild to severe.

An anal fissure could be acute or chronic. An acute fissure, which is more common, may heal by using at-home treatments. A chronic anal fissure, which is not common, is a lingering problem. Chronic fissures may need more intense treatment from a healthcare professional, which could include surgery.

This article includes a description of an anal fissure and how it is diagnosed and treated. 

Types of Anal Fissure

Anal fissures may be put into two types: acute and chronic.

Acute Anal Fissure

When the symptoms of an anal fissure get better with treatment within about six weeks, it’s considered acute. Anal fissures might improve by treating any underlying causes, like constipation (passing large, hard stools).

Chronic Anal Fissure

A chronic anal fissure is one that lasts more than six weeks. In a chronic fissure, the more conservative, at-home treatments haven’t worked. In that case, injections or surgery may be needed to heal it.

Anal Fissure Symptoms

Symptoms of an anal fissure can include:

• Bleeding from the rectum
• Pain in the anal area while having a bowel movement
• Pain in the anal area that lasts for hours after a bowel movement
• Tenderness or discomfort in the anal area

Causes

There are several potential causes and risk factors for developing an anal fissure. These include:

• Constipation: Hard stools from constipation are a risk factor.
• Chronic diarrhea: This is recurrent loose or frequent stools.
• Sexually transmitted infections (STIs): These include syphilis and herpes and are spread during sexual contact.
• Inflammatory bowel disease (IBD): These conditions show inflammation of the digestive tract, and may produce chronic diarrhea.
• Human immunodeficiency virus (HIV): This virus inhibits the immune system and is transmitted by body fluids, including through sex.
• Anal cancer
• Childbirth
• Anal surgery
• Anal sex
• Tuberculosis: Rarely, this bacterial infection may occur in the anal area and lead to a sore or fissure.
  

Anal fissures are common in infants and children, but they can happen to anyone at any stage of life. In babies and kids, the cause is usually passing a large, hard stool.

Diagnosis

A diagnosis of an anal fissure is usually made by a healthcare professional after discussing the symptoms and conducting a physical exam. The physical exam means looking at the anal area to see if there could be another reason for the pain or bleeding.

Tests to look inside the anal canal usually aren't used because they can cause more discomfort. Looking at the area should be done gently and as briefly as possible.

Treatment

Treatment usually starts with conservative measures and if the fissure doesn’t get better, more invasive therapies might be tried.

Comfort Measures

A sitz bath, soaking your bottom in shallow, warm water, can ease discomfort. This can be done by placing a shallow plastic tub, also called a sitz bath, beneath your toilet seat, or by sitting in a minimally filled, clean bathtub.

A healthcare professional may suggest adding Epsom salts (magnesium sulfate salts often used for soaking) to the water. A sitz bath might be used for about 20 minutes at a time, several times a day.

Pain might also be lessened by not using paper to wipe and instead using baby wipes, a squeeze bottle of water, or a bidet (a toilet attachment or separate bathroom fixture that sprays the anal area with water). 

Treating Constipation

If the reason for the fissure is from having hard bowel movements, making stools softer and easier to pass may help. Drinking more water, eating foods containing fiber, or using fiber supplements, stool softeners, or laxatives might be helpful. How much fiber and which fiber supplement to use should be talked over with a healthcare professional. 

For kids, it’s important to ensure that they’re not holding stool because going to the bathroom is painful. Holding stool can lead to a worsening of the constipation that caused the fissure in the first place.

Medications

Some medications might be used directly on the fissure to help with the pain and/or promote healing. 

Nitroglycerin rectal ointment is applied directly to the anus with a clean or gloved finger or with an applicator, as directed by your healthcare provider. This medication helps relax the muscles in the anus, which eases pain. For adults, it might be used twice a day.

Topical lidocaine is another medication that might help with painful bowel movements. This cream is applied with a clean or gloved finger or an applicator. It can be used twice a day.

Calcium channel blockers are a type of medication that treats blood pressure. They can also relax the muscles in the anus, which prevents spasms and discomfort. They might be given orally or topically (applied directly to the site). Using the topical form helps prevent side effects.

Botox Injections

An injection with Botox (botulinum toxin type A) may be used for anal fissures that aren’t improving with the less-invasive treatments. Botox is injected into the muscle of the anal sphincter by healthcare provider. This medication helps prevent spasms in the anal muscles, which can be painful.

Surgery

An operation, such as an anocutaneous flap (transferring a flap of living skin tissue onto the fissure), fissurectomy (cutting away the fissure), or sphincterotomy, might be used for anal fissures that won’t heal up with other measures.

The surgery most often used is a lateral internal sphincterotomy. This involves cutting the muscles in the anal sphincter, which helps it heal cleanly. Surgery is effective at treating a fissure, but any surgery carries risks. Surgery along with medications might be more effective in the long run.

Prognosis

Most cases of anal fissure will improve with the at-home measures such as avoiding constipation and/or some medications for pain and spasms.

Some people will develop a chronic fissure that may need to be treated with surgery. However, surgery has a good chance of curing the fissure. To prevent a chronic, recurring condition, it’s important is to keep up the self-care measures at home.

Coping

An anal fissure is painful and upsetting. The anal sphincter can take time to heal because it’s constantly in use for bowel movements. Seeking care early after having symptoms and following your healthcare provider's recommendations can help. Some people may also prefer to ask for a referral to a digestive disease specialist, such as a gastroenterologist.

Dealing with digestive problems and describing the symptoms can be embarrassing. It’s important to remember that healthcare professionals help their patients with digestive conditions all the time. Asking questions about anything that is unclear will help in getting on the right track.

Summary

An anal fissure is a crack or a tear in the anal canal. The treatment can include managing constipation, applying topical medications, and, in some cases, having surgery. Most people do well with conservative measures, and the fissure will not recur.

A Word From Verywell 

Anal fissures can be painful, and seeing blood in or on the stool can be a shock. However, it’s important to remember that anal fissures are a common problem and most people do well with conservative treatments.

The fissure is likely to heal and not recur. However, if this condition does become chronic or come back after treatment, surgical options work well and can provide relief, if needed.