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An anal fissure is a tear in the lining of the lower rectum (anal canal) that
causes pain during bowel movements. Anal fissures don't lead to more serious problems.
anal fissures heal with home treatment after a few days or weeks. These are called short-term (acute) anal
fissures. If you have an anal fissure that hasn't healed after 8 to 12 weeks, it is
considered a long-term (chronic) fissure. A chronic fissure may need medical treatment.
Anal fissures are a common problem. They affect people of all ages,
especially young and otherwise healthy people.
Anal fissures are
caused by injury or trauma to the anal canal. Injury can happen when:
Fissures can also be caused by
a rectal exam, anal intercourse, or a foreign object. In some cases, a fissure may be caused by
Many experts believe that extra tension in the two muscular
rings (sphincters) controlling the anus may be a cause of fissures. The outer anal sphincter is under
your conscious control. But the inner sphincter is not. This muscle is under pressure, or tension, all of the time. If the pressure increases too much, it can cause spasm and reduce blood flow to the anus, leading to a fissure. This pressure can also keep a fissure from healing.
You may have:
Sometimes an anal fissure may be a painless wound that won't heal. It may bleed from time to time but cause no other symptoms.
A doctor can diagnose an
anal fissure based on your symptoms and a physical
exam. The exam may include:
The doctor may wait until the fissure has started to heal before doing a rectal exam or anoscopy. If an exam needs to be
done right away, medicine can be used to numb the area.
During an exam, a doctor can also find out whether
another condition may be causing the fissure. Having several fissures or
having one or more in an area of the anus where fissures usually don't occur can be a sign of a more serious problem, such as inflammatory bowel disease or a weakened immune system.
Most short-term anal fissures can heal with home treatment in 4 to 6
weeks. Pain during bowel movements usually goes away within a couple of days after the start of
There are several steps you can take to relieve your symptoms and help the fissure heal:
Don't avoid having bowel movements. Knowing that it might hurt may make you anxious. But trying not to have bowel movements will only make constipation worse and keep the fissure open and painful.
About 9 out of 10 short-term fissures heal with home treatment—including using stool
softeners or fiber supplements and taking regular sitz baths. And about 4 out of 10 long-term
anal fissures will heal after home treatment is used.1
But not all fissures will heal with just home treatment. If a fissure lasts more than 8 to 12 weeks, you may need prescription medicines.
These may include nitroglycerin cream, high
blood pressure medicines in pill or gel form, or injections of botulinum toxin (Botox).
If medicines don't stop your symptoms, you may
need to consider surgery. The most
commonly used surgery is lateral internal sphincterotomy. In this procedure, a
doctor cuts into part of the internal sphincter to relax the spasm that is
causing the fissure.
Learning about anal fissure:
The American Society of Colon and Rectal Surgeons is the leading
professional society representing more than 1,000 board-certified colon and
rectal surgeons and other surgeons dedicated to treating people with diseases
and disorders affecting the colon, rectum, and anus.
Dozois EJ, Pemberton JH (2006). Anal fissure
section of Hemorrhoids and other anorectal disorders. In MM Wolfe et al., eds.,
Therapy of Digestive Disorders, pp. 948–950.
Other Works Consulted
Madoff RD, Fleshman JW (2003). American
Gastroenterological Association Medical position statement: Diagnosis and care
of patients with anal fissure. Gastroenterology, 124(1):
Marcello PW (2010). Diseases of the anorectum. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 2257–2267. Philadelphia: Saunders.
Nelson RL (2011). Operative procedures
for fissure in ano. Cochrane Database of Systematic Reviews (11).
Perry W, et al. (2010). Practice parameters for the management of anal fissures (3rd revision). Diseases of the Colon and Rectum, 53(8): 1110–1115.
Welton ML, et al. (2010). Anal fissure and ulcer section of Anorectum. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery. 13th ed., pp. 710–712. New York: McGraw-Hill.
May 15, 2012
Anne C. Poinier, MD - Internal Medicine & C. Dale Mercer, MD, FRCSC, FACS - General Surgery
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