What is the definition of Anal Fissure?

An anal fissure is a small split or tear in the thin moist tissue (mucosa) lining the lower rectum (anus).

What are the alternative names for Anal Fissure?

Fissure in ano; Anorectal fissure; Anal ulcer

What are the causes for Anal Fissure?

Anal fissures are very common in infants, but they may occur at any age.

In adults, fissures may be caused by passing large, hard stools, or having diarrhea for a long time. Other factors may include:

  • Decreased blood flow to the area
  • Too much tension in the sphincter muscles that control the anus

The condition affects males and females equally. Anal fissures are also common in women after childbirth and in people with Crohn disease.

What are the symptoms for Anal Fissure?

An anal fissure can be seen as a crack in the anal skin when the area is stretched slightly. The fissure is almost always in the middle. Anal fissures may cause painful bowel movements and bleeding. There may be blood on the outside of the stool or on the toilet paper (or baby wipes) after a bowel movement.

Symptoms may begin suddenly or develop slowly over time.

What are the current treatments for Anal Fissure?

Most fissures heal on their own and do not need treatment.

To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently.

CHILDREN AND ADULTS

Worrying about pain during a bowel movement may cause a person to avoid them. But not having bowel movements will only cause the stools to become even harder, which can make the anal fissure worse.

Prevent hard stools and constipation by:

  • Making dietary changes -- eating more fiber or bulk, such as fruits, vegetables, and grains
  • Drinking more fluids
  • Using stool softeners

Ask your provider about the following ointments or creams to help soothe the affected skin:

  • Numbing cream, if pain interferes with normal bowel movements
  • Petroleum jelly
  • Zinc oxide, 1% hydrocortisone cream, Preparation H, and other products

A sitz bath is a warm water bath used for healing or cleansing. Sit in the bath 2 to 3 times a day. The water should cover only the hips and buttocks.

If the anal fissures do not go away with home care methods, treatment may involve:

  • Botox injections into the muscle in the anus (anal sphincter)
  • Minor surgery to relax the anal muscle
  • Prescription creams, such as nitrates or calcium channel blockers, applied over the fissure to help relax the muscles

What is the outlook (prognosis) for Anal Fissure?

Anal fissures often heal quickly without any more problems.

People who develop fissures once are more likely to have them in the future.

Rectum
Anal

REFERENCES

Downs JM, Kulow B. Anal diseases. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 129.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Surgical conditions of the anus and rectum. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 371.

Merchea A, Larson DW. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 52.

  • Condition: Hemorrhoids
  • Journal: Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
  • Treatment Used: Shaobei Injection vs Elastic Band Ligation
  • Number of Patients: 60
  • Published —
This study compared the effectiveness, safety and economy of Shaobei injection versus elastic band ligation (involves placing a rubber band around hemorrhoids to cut off its blood supply) in the treatment of grade II or III hemorrhoids (swollen veins in the anus and lower rectum).
  • Condition: Children with Inflammatory Bowel Disease (IBD)
  • Journal: Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
  • Treatment Used: Surgical Intervention
  • Number of Patients: 21
  • Published —
This study evaluated the outcomes of surgical intervention in children with inflammatory bowel disease (disorders that involve chronic inflammation of the digestive tract; IBD).