Anal fissure

Overview

An anal fissure is a small tear in the lining of the anus, the opening at the end of the digestive tract where stool leaves the body. It can cause pain and bleeding during bowel movements.

Yes, anal fissures are fairly common, especially in infants and in people in their 20s and 30s. Many people experience them at some point in life.

Anyone can get an anal fissure, but they are very common in babies and young adults. Pregnant women and people who have given birth are also at higher risk.

Symptoms

Common symptoms

• Sharp stinging or burning pain during a bowel movement
• Bright red blood on the toilet paper or in the toilet bowl
• A visible tear or crack in the skin around the anus
• Itching or irritation around the anus

Symptoms in children

• Crying or fussing during bowel movements
• Trying to avoid pooping because it hurts
• Blood on the diaper or in the stool

Symptoms in older adults

• Less noticeable pain, but still may have bleeding
• Constipation due to fear of pain
• Irritation around the anus that may be mistaken for other conditions

Causes

Main causes

• Passing hard or large stools that stretch the anal lining
• Chronic constipation and straining to have a bowel movement
• Prolonged diarrhea that irritates the area

Risk factors

• Constipation
• Diarrhea
• Pregnancy and childbirth
• Anal sex
• Inflammatory bowel disease such as Crohn's disease

When to see a doctor

See a doctor urgently if:

• If you have heavy bleeding from the anus
• If you have severe pain that does not go away after trying home care

Book a routine appointment if:

• If you notice blood or pain for the first time
• If symptoms last more than 3 to 4 weeks without improvement

Diagnosis

Your doctor will ask about your symptoms and examine the area around the anus. Often the fissure is easy to see.

Tests that may be done

• Visual examination of the anal area
• Sometimes a gentle internal exam with a small tube called an anoscope to look at the anal canal

What to expect at your appointment

The exam is quick and may feel slightly uncomfortable, but it is not painful. Your doctor will explain what they are doing. No special preparation is usually needed.

Treatment

Treatment focuses on helping the fissure heal, reducing pain, and preventing it from coming back. Most fissures heal with simple home care.

Self-care at home

• Drink plenty of water and eat a high-fiber diet (fruits, vegetables, whole grains) to keep stools soft
• Soak in a warm bath (sitz bath) for 10 to 15 minutes two or three times a day
• Use over-the-counter stool softeners or fiber supplements – ask your pharmacist which one is right for you

Medical treatments

If self-care is not enough, your doctor may recommend a medicated cream that helps relax the anal muscle and improve blood flow. This can be applied to the area. In some cases, an injection or a minor procedure to relax the muscle may be used.

When is surgery considered?

Surgery is considered only if the fissure does not heal after several months of other treatments. The procedure, called a lateral internal sphincterotomy, gently loosens the anal muscle to allow the fissure to heal.

Living with this condition

Most people with an anal fissure can manage their symptoms and continue daily activities. The key is to keep stools soft and avoid straining.

Lifestyle tips

• Eat a high-fiber diet with plenty of fruits, vegetables, and whole grains
• Drink at least 8 glasses of water a day
• Go to the bathroom as soon as you feel the urge
• Use moist wipes or a bidet instead of dry toilet paper to avoid irritation

Diet and exercise

Regular physical activity helps keep the bowels regular. A diet rich in fiber and staying well hydrated are the best ways to prevent constipation and help the fissure heal.

Mental health and emotional wellbeing

Living with anal pain can be stressful and embarrassing. It is normal to feel anxious about bowel movements. If these feelings affect your daily life, talk to your doctor. You are not alone.

Prevention

Not always, but you can lower your risk by avoiding constipation. Eat a healthy diet high in fiber, drink enough fluids, and don't delay bowel movements.

Complications

If left untreated

• The fissure may become chronic, lasting more than 6 weeks and not healing on its own
• The anal muscle may tighten, causing more pain and making it harder for the fissure to heal
• A skin tag or small infection may develop around the area

Long-term outlook

With the right care, most anal fissures heal completely within a few weeks. Even chronic fissures can be treated effectively, often without surgery. Recovery is usually full, and most people return to normal activities without lasting problems.

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