Anal fissures happen when there is a split, tear, or crack in the lining of the anal canal. Anal fissures are commonly caused by constipation or straining during bowel movements which can irritate the anus. While common, there are remedies for anal fissures to heal on their own. In some rare cases, medication or surgery is necessary.
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What Are Anal Fissures?
Anal fissures are tears in the tissues lining the rectal canal where stool (poop) is stored until you are ready to go to the bathroom. The rectal canal or rectum connects to the anus – the opening on the backside where the digestive track ends and stool leaves the body.
In most cases, anal fissures occur during strained bowel movements when you’re constipated or from an injury that creates a crack or split in the area around the anus. Anal fissures typically last less than six weeks, called acute fissures, but can also last longer, called chronic fissures. Chronic anal fissures are typically deeper tears that can take longer to heal.
How common are anal fissures?
Anal fissures are common among children and adults in the United States, with more than 250,000 new cases every year in the United States. Most anal fissures heal on their own and go away with time. Rarely, more severe anal fissures can require surgical intervention.
What causes anal fissures?
Anal fissures are most commonly the result of:
- Anal intercourse.
- Chronic diarrhea.
- Hard stools after constipation.
- Injury from anal penetration.
- Sexually transmitted infections (STIs).
However, anal fissures can also be caused by:
- Anal cancer.
- Childbirth.
- HIV.
- Inflammatory bowel disease.
- Prior surgeries in or around the anus.
- Tuberculosis.
- Traumatic injury.
A fissure begins on the surface and usually heals rapidly on its own. Sometimes fissures may deepen to reach the underlying sphincter muscle (the muscle around the anus). It is not completely understood why some fissures heal and others do not. One major factor is persistent constipation or diarrhea, which can prevent healing.
In addition, each time stool passes the muscle goes into spasm, tightening the anal canal. If the sphincter muscle does not relax and the anal canal remains too tight, the fissure may open again with each bowel movement.
Rarely, a fissure can be caused by Crohn's disease or an infection. Treatment for the underlying disease usually relieves the fissure. Fissures rarely become infected and do not become cancerous.
Anal fissure risk factors
Risk factors to consider with anal fissures are:
- Age – Anal fissures are most common in infants but can occur in men and women of any age.
- Anal intercourse – Penetration in the anus increases your likelihood for tears in the anal canal.
- Childbirth – Straining and bearing down in childbirth can cause anal fissures in birthing people.
- Constipation – Straining to pass hard stools during a bowel movement is a common reason for anal fissures.
- Inflammatory bowel diseases – If you are diagnosed with Crohn’s disease or other diseases of the intestines and bowel, you may be more vulnerable to anal fissures.
- Previous anal fissures – Unfortunately, anal fissures can recur which means having one in the past increases your likelihood of having another one.
Complications of anal fissures
If left undiagnosed or untreated, anal fissures can become more severe and take longer to heal.
Other complications include:
- Anal bleeding.
- Fecal incontinence.
- Fistula formation.
- Infection.
An anal fissure that takes more than two months to fully heal can become chronic and may require further treatment, including surgery.
How can I reduce my risks of anal fissures?
While anal fissures can occur at any time, there are some lifestyle habits you can make to reduce your risk of constipation, such as:
- Eat foods high in fiber — Fiber-rich foods help soften your stool so it can pass more easily. Fruits, veggies, beans, seeds, and oat bran can all be beneficial if you need to consume more fiber. If you are struggling with constipation, it is best to avoid gluten, milk, red meat, and alcohol.
- Hydrate – Drink at least eight to 10 glasses of fluids a day that do not contain caffeine or alcohol.
- Take natural fiber supplements — Your doctor should prescribe these if they believe increasing your fiber intake in this way could be beneficial.
What Are the Signs and Symptoms of Anal Fissures?
The most common symptoms of anal fissures include:
- Itching — Discharge may result as the fissure alternately heals and reopens, causing itching.
- Rectal pain — People often describe it as burning or tearing pain during a bowel movement that may last for minutes or hours. The pain that lasts after a bowel movement is caused by spasms in the sphincter muscle.
- Rectal bleeding — Usually small amounts of bright red blood that can be seen on toilet paper or in toilet water.
- Swelling — Swelling at the outer end of the fissure can result in a skin tag. It may be noticed when cleaning the anus after a bowel movement.
- Visible crack — Some anal fissures can be seen when examining the skin around the anus.
How Do You Diagnose Anal Fissures?
Your doctor will ask about your symptoms and medical history, then perform a physical examination where they will inspect the skin around the anus. Doctors know that anal fissures can be tender and painful, so they will try to minimize touching the area. Anal fissures are typically easily visible and can be diagnosed quickly.
In rare cases, the fissure may not be as noticeable and may require more tests to diagnose.
Acute anal fissures can look like a recent tear or crack in the skin with some blood. Chronic anal fissures may look more established and deeper. Some chronic anal fissures may require examination under anesthesia to diagnose the exact cause.
If the fissure occurs on the sides of the anus, it is likely caused from an inflammatory bowel disease or other condition. Depending on your age and previous medical history, your doctor may order an anoscopy or colonoscopy to continue searching the anal cavity for cancer or other underlying medical conditions.
How Do You Treat Anal Fissures?
Most superficial fissures can heal with a conservative care routine that typically includes:
- Fiber supplementation — If needed, supplements can be taken to increase fiber intake.
- High-fiber diet — Eating foods high in fiber can help loosen stools and prevent constipation.
- Increased fluid intake — Drinking plenty of water helps avoid constipation and promote healing.
- Sitz baths — These warm water soaks can be done several times a day to ease pain around the anus and relax the sphincter.
- Stool softeners — These may be prescribed or encouraged to loosen stool and prevent constipation.
- Topical analgesics — Can be applied directly onto the painful area to relieve discomfort.
Some people with chronic or recurring anal fissures may need other treatment methods.
These include:
- Nitroglycerin — Helps increase blood flow to the area to promote healing.
- Botox injection — Significantly reduces pain.
- Blood pressure medications — Help relax the anal sphincter.
- Topical anesthetic creams — Help reduce swelling and promote healing.
Surgery for anal fissures
Sometimes, severe or chronic anal fissures require surgery to heal correctly. In these surgeries, you can expect a small part of the anal sphincter muscle to be cut, which can reduce pain and spams and help the area heal. This procedure, called lateral internal sphincterotomy (LIS), is very effective in treating anal fissure symptoms.
There is a risk of fecal incontinence that is rare but serious. It is best to talk over all your options with your doctor before choosing surgery.
Life after anal fissure treatment
The best way to avoid recurring anal fissures is to listen to your doctor’s post-treatment advice and to take all medications exactly as prescribed. It’s also important to keep your bowel movements healthy by focusing on a fiber-rich diet and consuming enough daily fluids. Avoiding spicy foods that may cause irritating bowel movements can also keep symptoms from worsening.
Many people recover fully from anal fissures can and do not have to deal with recurring symptoms.
