Anal fissure

What is an Anal fissure?

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fibre intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.


Signs and symptoms of an anal fissure include:

  • Pain, sometimes severe, during bowel movements
  • Pain after bowel movements that can last up to several hours
  • Bright red blood on the stool or toilet paper after a bowel movement
  • A visible crack in the skin around the anus
  • A small lump or skin tag on the skin near the anal fissure

When to see a doctor

See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.

Pro Tip

An important question to ask your doctor: What risk factors predisposed me to getting this fissure? _Piles Clinic UK

What Causes Anal Fissure?

Common causes of anal fissure include:

  • Passing large or hard stools
  • Constipation and straining during bowel movements
  • Chronic diarrhoea
  • Anal intercourse
  • Childbirth

Less common causes of anal fissures include:

  • Crohn’s disease or another inflammatory bowel disease
  • Anal cancer
  • HIV
  • Tuberculosis
  • Syphilis

Risk factors

Factors that may increase your risk of developing an anal fissure include:

  • Straining during bowel movements and passing hard stools increase the risk of tearing.
  • Anal fissures are more common in women after they give birth.
  • Crohn’s disease.This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.
  • Anal intercourse.
  • Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

Pro Tip

Fissures can happen spontaneously—they do not necessarily indicate any underlying chronic disease. But if they don’t heal on their own, it may be a sign of an underlying disease (i.e. inflammatory bowel disease) and may become chronic Fissure which are extremely difficult to treat. It may require medication or surgery, as well as further workup. —Piles Clinic UK

What are Complications from anal fissure?

Complications of anal fissure can include:

  • Failure to heal.An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment.
  • Once you’ve experienced an anal fissure, you are prone to having another one.
  • A tear that extends to surrounding muscles.An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure.


You may be able to prevent an anal fissure by taking measures to prevent constipation or diarrhoea. Eat high-fibre foods, drink fluids and exercise regularly to keep from having to strain during bowel movements.

How do I know if I have a haemorrhoid or a fissure?

Both anal fissures and haemorrhoids cause bleeding. But there is a big difference. An anal fissure is a tear of tissue and is very painful passing glass pieces and blood in stools. Haemorrhoids are a group of swollen veins inside the anal canal or at the anal opening and are usually cause painless bleeding in stools though some external Haemorrhoids can be painful.

Professionals at Piles Clinic UK can diagnosis and differentiate both with a careful history and examination and suggest treatment.

How is Anal fissure diagnosed?

Your doctor will likely ask about your medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually, this exam is all that’s needed to diagnose an anal fissure.

An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has a deeper tear, and may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks.

The fissure’s location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn’s disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition:

  • An anoscope is a tubular device inserted into the anus to help your doctor visualize the rectum and anus.
  • Flexible sigmoidoscopy.Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you’re younger than 50 and have no risk factors for intestinal diseases or colon cancer.
  • Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhoea.


What is the treatment for Anal fissure?

Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fibre and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.

Lifestyle and home remedies

Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences:

  • Add fibre to your diet. Eating about 25 to 30 grams of fibre a day can help keep stools soft and improve fissure healing. Fibre-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fibre supplement. Adding fibre may cause gas and bloating, so increase your intake gradually.
  • Drink adequate fluids. Fluids help prevent constipation.
  • Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear.

If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child’s doctor.

If your symptoms persist, you’ll likely need further treatment.

Nonsurgical treatments

Your doctor may recommend:


  • Nitrate ointment: This helps raise blood flow to the anal canal and sphincter, which helps fissures get better faster.
  • Calcium channel blockers: These are blood pressure-lowering medications. Some of the topical ones can treat anal fissures, too.
  • Botox injections: Injecting botulinum toxin type A (Botox) into the sphincter may relieve pain and encourage healing.

Pro Tip

Most of acute fissures are treated with non-surgical treatment which can last for few months. Patience and Lifestyle modification usually avoids surgery _Piles Clinic UK


For cases of chronic anal fissures that do not heal on their own, your doctor may recommend surgery. This is rare. Prior to surgery, your doctor might also want to use a scope to take a closer look at the anal tissue to help diagnose the cause of the fissure. If your doctor suspects anal cancer, they will take a biopsy.

If surgery is suggested, the surgeon will cut a portion of the anal muscle to relax it (lateral internal sphincterotomy). This will reduce pain and help healing.

Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence.

 Follow up

  • If the fissure doesn’t heal on its own within 1 to 2 weeks, make an appointment to see your doctor.
  • If you have surgery, follow up with your surgeon to make sure you’re healing well.
  • Drink lots of water and take a fibre supplement to prevent constipation. Make sure you’re having soft daily bowel movements
  • If your fissure is from an STI, talk with your doctor about how to best take care of the infection.
  • If your fissure is from inflammatory bowel disease or anal cancer, talk to your gastroenterologist or general surgeon about the best treatment.

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