Anal fissure

One in every ten people can be affected with anal fissures in their lifetime. These are cracks or tears in the lining of the lower rectum (anus). They do not cause serious problems and are not life-threatening. The condition can occur at any age, but most commonly seen in infants and young children.

Signs and symptoms

Signs and symptoms of anal fissure include:

  • Sharp, burning pain while passing stools, that often lasts for longer time
  • Bleeding when you pass stools
  • Itching
  • Reluctant to have a bowel movement (may lead to fecal impaction)
  • Discharge of pus from the fissure

Causes and risk factors

Anal fissures are caused by the trauma to the inner lining of the anus. The condition occurs due to passing dry or hard stools, straining during childbirth, tight anal sphincter muscles, or frequent bowel movements.

Anal fissures may also develop due to conditions such as anal cancer, herpes, HIV, or syphilis.

Anal Fissure Treatment

Mostly, anal fissures heal without the treatment. But if the condition becomes chronic, you may require interventions to promote healing.


Complications include recurrence and extension of the tear to the surrounding muscles. If the anal fissure fails to heal within six weeks, then the condition is considered to be chronic.

When to seek medical advice?

Anyone of us can experience anal fissures, so don’t let embarrassment stop you from seeking medical advice. Consult your doctor if you have severe pain during a bowel movement, or you notice blood on stools after a bowel movement or if the fissure persists for more than six weeks.


Diagnosis of anal fissure includes visual examination of anal area and a digital rectal exam. Digital rectal exam is performed by inserting an endoscope into the rectum to visualize the tear easily.

Generally, anal fissure appears as a paper cut. In the case of a chronic fissure, a tear will be present along with two lumps or tags of skin, one internal and one external. The internal lump is called sentinel pile, and the external lump is called hypertrophied papilla.

The goal of non-surgical treatment is to reduce the pain, make the stool soft for easy bowel movement.

  • Using stool-softeners
  • Applying nitroglycerin ointment
  • Applying topical anesthetic creams such as lidocaine
  • Taking sitz baths to relax anal muscles
  • Treating with Botox (Botulinum toxin type A) injection to prevent spasms in the anal muscles by paralyzing them

Surgery is indicated in chronic anal fissure treatment and for cases that cannot be cured with other treatments, then your doctor opts for surgery. Lateral internal sphincterotomy (LIS) is the common surgery performed to treat anal fissures. The procedure involves cutting a small part of the anal muscle to reduce spasms and promote healing.

Inflammatory bowel disease or anal tumors also have similar symptoms. So your doctor may further evaluate the condition if the fissure doesn’t heal with the treatment.

Fissure in anus can always be prevented by following some simple tips:

  • Cleanse the anal area with warm water and mild soap
  • Drink plenty of fluids
  • Consume fiber-rich diet
  • Perform physical activity regularly
  • Treat conditions such as constipation and diarrhea immediately

In the case of infants, change the diapers frequently and keep the anal area dry.