An anal fissure is a tear in the lining of the lower rectum (anal canal) that causes pain during bowel movements. Anal fissures don't lead to more serious problems.
Most anal fissures heal with home treatment after a few days or weeks. These are called short-term (acute) anal fissures. If you have an anal fissure that hasn't healed after 8 to 12 weeks, it is considered a long-term (chronic) fissure. A chronic fissure may need medical treatment.
Anal fissures are a common problem. They affect people of all ages, especially young and otherwise healthy people.
Anal fissures are caused by injury or trauma to the anal canal. Injury can happen when:
Fissures can also be caused by a rectal exam, anal intercourse, or a foreign object. In some cases, a fissure may be caused by Crohn's disease.
Many experts believe that extra tension in the two muscular rings (sphincters) controlling the anus may be a cause of fissures. The outer anal sphincter is under your conscious control. But the inner sphincter is not. This muscle is under pressure, or tension, all of the time. If the pressure increases too much, it can cause spasm and reduce blood flow to the anus, leading to a fissure. This pressure can also keep a fissure from healing.
You may have:
Sometimes an anal fissure may be a painless wound that won't heal. It may bleed from time to time but cause no other symptoms.
A doctor can diagnose an anal fissure based on your symptoms and a physical exam. The exam may include:
The doctor may wait until the fissure has started to heal before doing a rectal exam or anoscopy. If an exam needs to be done right away, medicine can be used to numb the area.
During an exam, a doctor can also find out whether another condition may be causing the fissure. Having several fissures or having one or more in an area of the anus where fissures usually don't occur can be a sign of a more serious problem, such as inflammatory bowel disease or a weakened immune system.
Most short-term anal fissures can heal with home treatment in 4 to 6 weeks. Pain during bowel movements usually goes away within a couple of days after the start of home treatment.
There are several steps you can take to relieve your symptoms and help the fissure heal:
Don't avoid having bowel movements. Knowing that it might hurt may make you anxious. But trying not to have bowel movements will only make constipation worse and keep the fissure open and painful.
About 9 out of 10 short-term fissures heal with home treatment—including using stool softeners or fiber supplements and taking regular sitz baths. And about 4 out of 10 long-term anal fissures will heal after home treatment is used.footnote 1
But not all fissures will heal with just home treatment. If a fissure lasts more than 8 to 12 weeks, you may need prescription medicines. These may include nitroglycerin cream, high blood pressure medicines in pill or gel form, or injections of botulinum toxin (Botox).
If medicines don't stop your symptoms, you may need to consider surgery. The most commonly used surgery is lateral internal sphincterotomy. In this procedure, a doctor cuts into part of the internal sphincter to relax the spasm that is causing the fissure.
Dozois EJ, Pemberton JH (2006). Anal fissure section of Hemorrhoids and other anorectal disorders. In MM Wolfe et al., eds., Therapy of Digestive Disorders, pp. 948–950. Philadelphia: Elsevier.
Other Works Consulted
Madoff RD, Fleshman JW (2003). American Gastroenterological Association Medical position statement: Diagnosis and care of patients with anal fissure. Gastroenterology, 124(1): 233–234.
Marcello PW (2010). Diseases of the anorectum. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 2257–2267. Philadelphia: Saunders.
Nelson RL (2011). Operative procedures for fissure in ano. Cochrane Database of Systematic Reviews (11).
Perry W, et al. (2010). Practice parameters for the management of anal fissures (3rd revision). Diseases of the Colon and Rectum, 53(8): 1110–1115.
Welton ML, et al. (2010). Anal fissure and ulcer section of Anorectum. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery. 13th ed., pp. 710–712. New York: McGraw-Hill.
Current as of: August 12, 2019
Author: Healthwise StaffMedical Review: Anne C. Poinier, MD - Internal MedicineAdam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineC. Dale Mercer, MD - General Surgery
Current as of: August 12, 2019
Author: Healthwise Staff
Medical Review:Anne C. Poinier, MD - Internal Medicine & Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & C. Dale Mercer, MD - General Surgery
To learn more about Healthwise, visit Healthwise.org.
© 1995-2020 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.