What is an anal fissure?
An anal fissure is a tear
in the lining of the lower rectum (anus) that
causes pain during bowel movements. It is a common condition. Anal fissures do
not lead to more serious conditions.
anal fissures heal with home treatment after a few days or weeks (acute anal
fissures). If you have an anal fissure that has not healed after 6 weeks, it is
considered a long-term problem (chronic). You may need medicine to help
a chronic anal fissure heal. Surgery may be necessary for fissures that do not
heal with medicine.
Anal fissures affect people of all ages,
particularly young and otherwise healthy people. They are equally common in men
Sometimes an anal fissure and a
hemorrhoid develop at the same time.
What causes an anal fissure?
Anal fissures are
caused by injury (trauma) to the anal canal. Injury can happen if:
- You pass a large stool that stretches the
- You are constipated and try to pass a hard
- You have repeated diarrhea.
Childbirth can also cause trauma to the anal canal. During
childbirth, some women develop anal fissures. Fissures can also be caused by
digital insertion (as during an examination), foreign body insertion, or anal
Because many people get constipated or have diarrhea
without getting anal fissures, many experts believe there is some other cause
of anal fissures. Some people may have excessive tension in the two muscular
rings (sphincters) controlling the anus. The external anal sphincter is under
your conscious control. But the internal anal sphincter is not under your
control. This muscle remains under pressure, or tension, all of the time. A
fissure may develop if the internal sphincter's resting pressure becomes too
high, causing spasm and reducing blood flow to the anus. This high resting
pressure can also keep a fissure from healing.
In some cases, an
anal fissure may be caused by
Crohn's disease, an inflammatory bowel disease (IBD)
that causes bloody diarrhea, abdominal (belly) pain, fever, weight loss, and
fistulas near the anus.
What are the symptoms?
An anal fissure causes a
sharp, stinging, or burning pain during a bowel movement. The pain, which can
be severe, may last for a few hours.
Fissures may itch. They often
bleed lightly or cause a yellowish discharge. You may see a small spot of
bright red blood on toilet tissue or a few drops in the toilet bowl. The blood
is separate from the stool. Very dark, tarry stools or dark red blood mixed
with stool indicates some other condition, possibly
inflammatory bowel disease (IBD) or colon cancer. You
should contact a doctor if you have any bleeding with bowel movements.
Sometimes an anal fissure may be a painless wound that won't heal and
that bleeds intermittently but causes no other symptoms.
How is an anal fissure diagnosed?