An anal fissure is a small tear or cut in the lining of the anus. It can cause pain and bleeding during and after bowel movements.

Causes of Anal Fissure

Anal fissures are commonly caused by:

• Passing large or hard stools

• Constipation and straining during bowel movements

• Chronic diarrhea

• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)

• Childbirth (less common)

Symptoms of Anal Fissure

Symptoms of an anal fissure may include:

• Sharp pain during bowel movements

• Pain that persists for several hours after a bowel movement

• Bright red blood on stool or toilet paper after a bowel movement

• A visible crack in the skin around the anus

• Itching or irritation around the anus

• A small lump of skin (skin tag) near the fissure

Diagnosis of Anal Fissure

Diagnosis typically involves:

• Medical history taking: Discussing symptoms and bowel habits.

• Physical examination: A gentle visual inspection of the anus, often sufficient to identify the fissure. A digital rectal exam may be performed carefully if tolerated.

• Further tests: If the fissure is chronic or the cause is unclear, a colonoscopy or sigmoidoscopy may be recommended to rule out underlying conditions like inflammatory bowel disease.

Treatment of Anal Fissure

The goal of treatment is to relieve pain, promote healing, and prevent recurrence.

• Conservative management (for acute fissures):

  • Dietary changes: Increasing fiber intake (fruits, vegetables, whole grains) to soften stools.

  • Increased fluid intake: To prevent constipation.

  • Stool softeners or laxatives: To make bowel movements easier.

  • Warm sitz baths: Soaking the anal area in warm water for 15-20 minutes, several times a day, can help relax the anal sphincter and promote blood flow for healing.

  • Topical pain relievers: Over-the-counter creams or ointments (e.g., lidocaine) for pain relief.

  • Topical medications to relax the sphincter: Such as nitroglycerin ointment or calcium channel blocker creams (e.g., diltiazem, nifedipine) to reduce spasm and improve blood flow.

• Medical procedures (for chronic fissures or those not responding to conservative treatment):

  • Botulinum toxin (Botox) injection: Injected into the anal sphincter to temporarily paralyze the muscle, reducing spasm and allowing the fissure to heal.

  • Surgery (Lateral Internal Sphincterotomy – LIS): A minor surgical procedure to cut a small portion of the internal anal sphincter muscle, which helps to reduce anal pressure and allow the fissure to heal. This is highly effective but carries a small risk of incontinence.

• Addressing underlying causes: Treating conditions like Crohn’s disease if they are contributing to the fissure.

Prevention of Anal Fissure

Preventing constipation and straining during bowel movements is key:

• Maintain a high-fiber diet.

• Drink plenty of fluids.

• Exercise regularly.

• Avoid prolonged sitting on the toilet.

• Address any underlying medical conditions that cause constipation or diarrhea.