What Are Anal Fissures?
An anal fissure is a cut or a tear in the thin, delicate lining of your anus.
The tear often exposes the muscle around the anus, called the anal sphincter. The damage can cause that muscle to spasm, which can pull apart the edges of the fissure even more. The spasms can cause pain and slow down healing. Bowel movements can also keep the fissures from getting better.
An anal fissure is considered acute if it just happened or if you've had it less than 6 weeks. It's considered chronic (or long-term) if it's been more than 6 weeks or if it comes back often.
Anal Fissure Symptoms
If you have an acute anal fissure, you may feel a tearing or ripping sensation in that area during bowel movements. You may also notice:
- A visible tear in the anus
- Pain during bowel movements
- Blood on toilet paper after you wipe
- Blood on the surface of your stools
- Bleeding that discolors toilet water
- A bad-smelling discharge
Chronic anal fissure symptoms
Signs that a fissure has become chronic can include:
- Painful bowel movements without bleeding
- Itching and irritation of the skin around the anus
- A skin tag at the end of a fissure
Who Gets Anal Fissures?
These tears are common, although you might think the pain and bleeding are symptoms of other conditions, like hemorrhoids. They can happen to both men and women. They can also happen to babies.
Adults between the ages of 20 and 40 are most likely to get them. But you can have them at any age, even though your risk generally goes down as you get older.
Anal fissures are seen more often with certain medical conditions, such as:
- Anal cancer
- Leukemia
- STDs and HIV
- Complications from other conditions, like Crohn’s disease or ulcerative colitis
Anal Fissure Causes
They're caused by trauma or injury that stretches your anal canal. Reasons for this can include:
- Constipation or passing large or hard stools
- Explosive or ongoing diarrhea
- Childbirth
Less often, having anal sex or putting things into your anus can overstretch the skin and cause a fissure.
Too much pressure, tight anal sphincter muscles, and poor blood supply to your anus may lead to their development and poor healing.
Anal fissures don't usually give way to more serious problems. They don’t cause cancer. But they can be very uncomfortable.
To help these fissures heal and keep them from coming back:
- Eat a healthy diet that has plenty of fiber.
- Stay well-hydrated.
- Avoid being constipated.
Anal Fissure Diagnosis
You can easily mistake these symptoms as signs of other conditions, such as hemorrhoids.
You might not be comfortable telling your doctor about these problems, but it's important to do so. That way, they can rule out more serious conditions.
What to tell your doctor
In most cases, talking about your symptoms can give your doctor enough information to diagnose it. Be sure to tell them:
- When you have pain, or when your anus is burning or itching
- How bad your discomfort is
- How long the pain and discomfort usually lasts
- What type of bleeding you've seen
- What, if anything, improves your symptoms
Your doctor may ask about your diet, how often you poop (and other details about that), and if you have any other medical conditions or intestinal problems.
Anal fissure tests
Even though your doctor can usually diagnose an anal fissure from the symptoms you tell them, the best way to learn whether you have one is with a physical exam. Your doctor may look at the area to see whether there's a fissure.
You probably won't need a rectal exam (when the doctor uses a gloved finger to feel inside the anus) or an anoscopy (when the doctor puts a lighted scope into the anal canal). Sometimes they're necessary, though.
Generally, a visual exam of the area is all it takes. But if your doctor thinks an inflammatory bowel disease has caused the anal fissure, you might need more tests. Often, the number and location of anal fissures can point to other conditions, like Crohn’s disease. The presence of a skin tag at one end of a fissure may also point to chronic anal fissures.
Your doctor might also suggest a test called a sigmoidoscopy to see the lower part of the colon, or the sigmoid colon. Or you may need a colonoscopy to look at the whole large intestine. Both tests involve inserting a long, thin, flexible, lighted tube into your anus to view the colon. They're used to look for abnormal growths or inflammatory conditions.
Anal Fissure Treatment
The goal of treatment is to relieve pain and discomfort, and heal the torn lining.
Acute anal fissure treatment
Acute anal fissures – the ones that don't last longer than 6 weeks – are common and usually heal on their own with self-care.
Chronic anal fissure treatment
Chronic anal fissures – those that last longer than 6 weeks – may be more involved and require a treatment plan. You may need medicine or surgery to help them heal.
Anal fissure self-care
Sitz baths may help to heal your anal fissure. To take one, sit in warm water for 10-20 minutes. Don't use soap or put anything else in the water. Do this several times throughout the day, especially after you poop.
If you still have symptoms after a month or two, you probably need medical treatment.
Anal fissure medications
Your doctor might suggest:
- Nitrate ointment. Your doctor may prescribe this to help increase blood flow to the anal canal and sphincter, which helps fissures get better faster. You might hear it called nitroglycerin ointment (Rectiv, Rectogesic). Some side effects may include headaches, dizziness, and low blood pressure. Nitrate ointment should not be used within 24 hours of taking erectile dysfunction medicines like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra).
- Calcium channel blockers. These are blood pressure-lowering medications. Some of the topical ones can treat anal fissures, too. Side effects may include headaches.
- Topical anesthetic. Your doctor might suggest this if you have serious pain when you go to the bathroom. The anesthetic (lidocaine) comes in a gel or ointment and numbs the area. It won't help the fissure heal, but it can ease the pain. It might cause stinging or a little swelling.
- Botox shots. If topical treatments don't work, injecting botulinum toxin type A (Botox) into the sphincter is sometimes the next step. Botox injections paralyze the sphincter muscle for a short time, easing pain and helping the tear to heal in 60% to 80% of people. You may not be able to control your bowel movements or passing gas, but it's temporary. The dose is extremely low, so there is no risk of botulism poisoning.
Surgery
You probably won't need surgery for anal fissures unless other forms of treatment haven't worked. The surgery, called a lateral internal sphincterotomy (LIS), involves making a small cut in the anal sphincter muscle. It reduces pain and pressure, allowing the fissure to heal.
The pain from this surgery is usually mild. It can hurt less than the fissure itself. The surgery might be followed by temporarily not being able to control passing gas, a small amount of poop leakage, or an infection. But in most cases, complete healing of fissures takes place within 8 weeks after surgery.
Signs an Anal Fissure Is Healing
Most anal fissures heal in a few days or weeks. The biggest sign that it's getting better is you stop feeling pain when you poop. You also may notice no blood when you go to the bathroom.
Anal Fissure Complications
Acute anal fissures usually clear up within a few weeks, but they can become chronic when they take longer to heal or the tissue keeps tearing over and over. Fissures can cause some complications if they don't heal within a few weeks, including:
- Very serious constipation, when you can't poop and the stool backs up in your large intestine
- Anal stenosis, or when your anal canal becomes so narrow, it's very hard to poop
- Anal fistula, when the fissure gets infected, drains pus, and creates a tunnel to your outside skin
Anal Fissure Prevention
Once you have an anal fissure, you'll definitely want to avoid getting another one, so follow these simple steps.
Get plenty of fiber. If you're constipated, passing large, hard, or dry stools can cause an anal fissure. Getting plenty of fiber in your diet – especially from fruits and vegetables – can help prevent constipation, though.
Get 20 to 35 grams of fiber per day. Foods that are good sources include:
- Wheat bran
- Oat bran
- Whole grains, including brown rice, oatmeal, popcorn, and whole-grain pastas, cereals, and breads
- Peas and beans
- Seeds and nuts
- Citrus fruits
- Prunes and prune juice
If you can’t get enough fiber through your diet, try fiber supplements.
Whether you eat more fiber-rich foods or take supplements, boost your intake gradually until you notice softer, more-frequent bowel movements. Also, drink plenty of liquids as you take in more fiber. This will help you avoid bloating and gas.
Stay hydrated. That can help you prevent constipation. Drinking plenty of liquids adds fluid to your system, which can make stools softer and easier to pass. Be sure to drink more when the weather gets warmer or as you become more physically active.
Not all drinks are good choices for staying hydrated. Too much alcohol can dehydrate you. Also, although a caffeinated drink may help you go to the bathroom, too much caffeine can dehydrate you, too.
Exercise. One of the most common causes of constipation is a lack of physical activity. Exercise for at least 30 minutes most days to help keep your digestive system moving and in good shape. Work toward 150 minutes or more per week.
Don't ignore your urge to go. If your body tells you it's time to have a bowel movement, don't put it off till later. Waiting too long or too often can weaken the signals that let you know it's time to go. The longer you hold it in, the dryer and harder it can get, which makes it tougher to pass.
Practice healthy bathroom habits. These tips can help lessen constipation and strain on the anal canal. Check these habits regularly to lower your risk of getting a painful anal fissure:
- When using the bathroom, give yourself enough time to pass bowel movements comfortably. But don't sit on the toilet too long.
- Don’t strain while you are pooping.
- Keep the anal area dry.
- Gently clean yourself after each bowel movement.
- Use soft, dye-free, and scent-free toilet paper or wipes. Avoid ones that have alcohol.
- Get treatment for ongoing diarrhea.
If you have other conditions that contribute to anal fissures – like Crohn’s disease or irritable bowel syndrome (IBS), for example – stay on top of your treatment.
Ask your doctor about laxatives. If adding fiber to your diet and taking fiber supplements aren't enough to treat constipation, laxatives may help. Some work in different ways.
Bulk-forming laxatives, or fiber supplements, increase your stools by allowing them to absorb and hold fluid. They're considered the safest kind of laxative. They also encourage contractions in the colon to move stools along. Bulk-forming laxatives include calcium polycarbophil, methylcellulose, psyllium, and wheat dextrin. You take them with water.
Other types of laxatives can help by:
- Increasing the amount of water in the intestines
- Lubricating stools so they can move more easily (mineral oil)
- Drawing or pulling water into the colon
- Stimulating the muscles in the intestines to speed up bowel movements
Ask your doctor which kind of laxative – if any – is right for you, and how long you should take it.
Avoid things that will irritate your skin. This includes scented soaps or certain kinds of bubble baths.
Anal Fissures in Babies
Babies can get anal fissures, too. In fact, they're common in young kids. Constipation is most often the cause, when your baby has hard or large poop. So let your doctor know if they show any signs of constipation. Make sure their diaper is changed regularly.
The doctor may suggest having your baby sit in a warm bath two or three times a day to ease the pain and help heal the fissure. Using petroleum jelly or zinc oxide ointment can also help your baby's bottom feel better.
Takeaways
An anal fissure is a tear in the thin tissue that lines your anus. Make an appointment with your doctor if:
- It's very painful to poop.
- You see blood on your stools, in the toilet, or on toilet paper after you poop.
Anal Fissure FAQs
- Do anal fissures go away?
Fissures can get better on their own in a few weeks. It's important to try to prevent getting constipated so your poop stays soft. You can eat more fiber, drink more liquids, and take a fiber supplement. Your doctor might suggest a stool softener or laxative. Sitz baths may also help heal fissures.
- How do I know if I have a hemorrhoid or a fissure?
Both anal fissures and hemorrhoids can happen when you poop hard stools. A fissure is a tear in the tissue that lines your anus. Hemorrhoids are inflamed blood vessels in or just outside your anus. They form when too much pressure is put on the veins over and over.