Anal Fissure

What is an anal fissure?

An anal fissure is a small tear in the skin of the anus. The anus is the opening of the rectum where bowel movements (BMs) leave the body. Anal fissures are a fairly common problem.

How does it occur?

A tear may occur when you have:

• hard, dry bowel movements
• constipation
• hemorrhoids
• anal surgery
• inflammation of the rectum caused by intestinal problems such as Crohn's disease.

What are the symptoms?

Symptoms can include:

• pain during or after bowel movements
• cramping of the muscle at the opening of the anus caused by irritation of the tear during a bowel movement
• bright red blood when you have a bowel movement (you may see the blood on the BM, in the toilet water, or on toilet tissue you have used).

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have a procedure called an anoscopy to confirm the diagnosis. For this procedure your provider uses an instrument with a light called an anoscope to examine the anus and lower part of the rectum.

Your healthcare provider may recommend other tests or procedures, such as a sigmoidoscopy or colonoscopy, to learn more about the cause of the fissure or the bleeding.

How is it treated?

Most fissures will heal with the following at-home treatments:

• Your healthcare provider may recommend a stool softener, such as Haley's M-O, psyllium, Metamucil or Citrucel, or mineral oil.
• It may help to drink lots of water and add more fiber to your diet.
• For pain, your provider may recommend or prescribe use of pain-relieving cream or ointment, such as hydrocortisone or pramoxine, for a few days.
• Soaking in a warm bath may also help to relieve pain.

For fissures that come back or do not heal, medicines can be put inside the anus to try to relax the muscles of the sphincter and allow the fissure to heal. Examples of medicines being used for this treatment include nitroglycerin cream or botulinum (Botox) shots. If this does not help the fissure heal, then surgery to make a cut in the anal sphincter muscle may be needed to help the fissure heal. This is called an internal anal sphincterotomy. This surgical procedure stops the painful spasms, allows for much easier bowel movements, and helps the tear to heal. There is a small possibility of loss of control of your bowel (causing gas or stool leakage) after this surgery.

How long will the effects last?

An anal fissure usually heals by itself in a few days. If you have muscle spasms, it may take longer to heal.

How can I take care of myself?

Follow these guidelines to treat an anal fissure:

• Keep your bowel movements soft:
  • Follow your healthcare provider's instructions for taking stool-softening medicines.
  • Drink plenty of water.
  • Add more fiber to your diet with whole-grain foods, bran, and raw fruits and vegetables.
  • Be as physically active as your provider recommends.
• After bowel movements, gently wipe the area around the anus with clean, moist pads. This will remove irritating particles and fluid from the anal area.
• Soak in warm baths to help relieve pain and keep the area clean.

Contact your healthcare provider for advice if you are using nonprescription pain-relieving creams or ointments for more than a few days. Many of these products cause allergic skin reactions and worsen your problem.

What can I do to help prevent anal fissures?

The best prevention for anal fissures is to keep your bowel movements soft and to maintain a healthy lower intestinal tract. This includes:

• drinking plenty of water
• eating foods high in fiber
• being physically active.