Key Points about Anal Fissures

  • Anal fissures are small tears in the lining of the anal canal.
  • A bowel movement or stretching of the anal canal can cause anal fissures.
  • Anal fissures can cause sharp pain during a bowel movement.
  • Bright red blood on the stool after a bowel movement is common.
  • A high fiber diet can help make stools soft and reduce the symptoms.

Overview

An anal fissure is a small tear in the lining of the anal canal. Anal fissures are different than hemorrhoids and are common in people who have hard stools during bowel movements or loose, frequent bowel movements. While this condition can be very uncomfortable, an anal fissure does not cause cancer or other serious problems.

Anal fissure causes

Patients with a tight anal sphincter muscle are more likely to have anal fissures. Other causes include:

  • Anal infections or tumors
  • Childbirth
  • Constipation
  • Hard stools or frequent diarrhea over a long period
  • Inflammatory bowel disease
  • Reduced blood flow to the anal cavity
  • Trauma to the inner lining of the anus

Anal fissure risk factors

Anal fissures affect both men and women equally. However, they are common in women after childbirth. Some studies show a higher risk in people with Crohn’s disease.

Anal fissures are also more common with certain medical conditions, including anal cancer, sexually transmitted infections and ulcerative colitis.

Anal fissure symptoms

There are several symptoms of an anal fissure, including sharp pain during a bowel movementThe pain can sometimes be severe and last several minutes to a few hours.

Other symptoms include:

  • Bright red blood on the toilet paper after a bowel movement
  • Blood on the surface of the stool
  • A small crack or skin tag on the skin near the anal fissure

Anal fissure diagnosis

A simple visual exam of the rectum area can usually diagnose an anal fissure. Sometimes a rectal exam to view the inside of the rectum is necessary to accurately diagnose the condition. If this is needed, your doctor may perform an anoscopy which involves a short tube called an anoscope to view the inside of the rectum.

Sometimes a referral to a colorectal surgeon or gastroenterologist is necessary. These specialists can perform a sigmoidoscopy — an exam of the rectum and lower part of the colon.

Anal fissure treatment

Most anal fissures heal on their own within four to six weeks and can be treated at home. Treatment to reduce symptoms and heal the area includes:

  • Drinking plenty of water to help prevent hard stools
  • Eating high-fiber foods
  • Sitting in warm water (sitz bath) for 10 to 20 minutes each day
  • Using a stool softener
  • Using over-the-counter topical creams to reduce minor pain or rectal wipes containing zinc oxide to soothe the area
  • Using soft tissues or cotton balls soaked in warm water rather than toilet paper

If the anal fissure doesn’t go away with these home remedies, your doctor may suggest Botox injections into the muscle in the anus, prescription creams or minor surgery.

When to seek care

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, they may suggest seeing a gastroenterologist for more specialized treatment.