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Anal Fissure - Topic Overview

Most doctors can diagnose an anal fissure from symptoms and by looking at the anus. Usually, the doctor can see the fissure by gently separating the buttocks.

A doctor may use a gloved finger (digital rectal examination) or a lighted instrument (anoscope) to examine the fissure. But if the fissure is extremely painful, the doctor will usually wait until it has begun to heal before performing a rectal exam or using an anoscope (anoscopy) to rule out other problems. A topical anesthetic may be used if an immediate examination is necessary.

During an exam, a doctor can also find out whether another condition may be causing the fissure. If you have several fissures or have one or more in an area of the anus where fissures usually do not occur, you may have another condition such as inflammatory bowel disease, syphilis, a suppressed immune system, tuberculosis, HIV infection, or anal cancer. Most fissures occur along the midline-the top or bottom-of the anus.

How is it treated?

Most acute fissures need some home treatment, including soaking in a shallow tub of warm water (sitz bath) 2 or 3 times a day, increasing fiber in the diet, and taking stool softeners or laxatives. Some people find relief in a day or two of home treatment. Although your pain may go away, it may take several weeks for the fissure to heal completely. Sometimes fissures heal without treatment.

Try to prevent constipation, because it can keep a fissure from healing. The pain of a fissure may make you anxious about having bowel movements. But trying not to have bowel movements will only increase constipation and create a cycle that keeps the fissure open and painful.

Drinking lots of water or other fluids also will make stools softer and easier to pass.

You may want to use a nonprescription ointment such as zinc oxide, Preparation H, Anusol, or 1% hydrocortisone to soothe anal tissues. But evidence suggests that fiber and sitz baths help symptoms better than nonprescription creams.1 Talk with your doctor about whether you should use these medicines for a short period of time.

If a fissure lasts a long time, prescription medicine may help. Prescription medicines used to treat anal fissure include nitroglycerin, high blood pressure medicines, and botulinum toxin (Botox).

You may need to consider surgery if medicines do not stop your symptoms. 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:

Being diagnosed:

Getting treatment:


WebMD Medical Reference from Healthwise

Last Updated: May 25, 2010
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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