Patient education: Anal fissure (The Basics)

What is an anal fissure? — 

This is a tear in the lining of the anus, the opening where bowel movements come out (figure 1). An anal fissures causes pain, especially during a bowel movement.

A muscle called the "anal sphincter" wraps around the anus and holds it shut. The sphincter gets tense when the anus is injured. In people with anal fissures, the sphincter goes into spasms, which can lead to further injury.

What causes an anal fissure? — 

It is most often caused by having a hard, dry bowel movement.

What are the symptoms of an anal fissure? — 

Most people feel a tearing, ripping, or burning pain when they have a bowel movement. The pain can last for hours. Some people also bleed slightly when they have a bowel movement. They might see bright red blood on the toilet paper or on the surface of the bowel movement. Some people also have itching or irritation around the anus.

Should I see my doctor or nurse? — 

Yes. See your doctor or nurse if you bleed when you have a bowel movement.

Will I need tests? — 

Your doctor or nurse will check whether you have anal fissure by gently spreading your buttocks apart and looking at your anus.

If you had bleeding, your doctor or nurse might send you for more testing once the fissure has healed. This involves a "sigmoidoscopy" or "colonoscopy" (figure 2). For these tests, the doctor puts a thin tube into your anus and up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon and check for causes of bleeding.

How are anal fissures treated? — 

For the first month of treatment, doctors recommend trying to keep your bowel movements soft so they are easier to pass. To do this, you can:

●Take fiber supplements, along with plenty of water. Supplements include:

•Psyllium (sample brand name: Metamucil)

•Methylcellulose (sample brand name: Citrucel)

•Calcium polycarbophil (sample brand name: FiberCon)

•Wheat dextrin (sample brand name: Benefiber)

●Take a stool softener if the fiber supplements are not helping enough. An example is docusate (sample brand name: Colace).

Your doctor can also prescribe a medicine to relax your anal sphincter muscle. This helps the fissure heal. The most commonly used medicine is nitroglycerin or nifedipine cream. Smear the cream around the fissure twice a day every day. Keep doing this for as long as your doctor tells you to, even if you do not have pain every day. This lets your fissure heal completely.

You can also take "sitz baths." This is when you soak your buttocks in 2 or 3 inches of warm water for 10 to 15 minutes, 2 or 3 times a day. This can help relieve pain by relaxing your sphincter. Do not add soap, bubble bath, or anything else to the water.

If these steps to do not work in 1 to 2 months, doctors can try other treatments, such as:

●A shot of botulinum toxin ("BoTox") – This can help the anal sphincter muscle relax and heal. It can help, but it can also cause short-term problems with leaking of gas or bowel movements.

●Surgery – The doctor makes a small cut in the sphincter to help it relax. This works in most patients, but doctors offer it only to people who do not get better with other treatments. Surgery can cause lasting problems with leaking of gas or bowel movements.

More on this topic

Patient education: Bloody stools in adults (The Basics)
Patient education: Bloody stools in children (The Basics)
Patient education: Sigmoidoscopy (The Basics)
Patient education: Colonoscopy (The Basics)
Patient education: Constipation in adults (The Basics)
Patient education: Constipation in children (The Basics)
Patient education: High-fiber diet (The Basics)
Patient education: How to use rectal medicines (The Basics)
Patient education: How to take a sitz bath (The Basics)
Patient education: Botulinum toxin injections (The Basics)

Patient education: Anal fissure (Beyond the Basics)
Patient education: Blood in the stool (rectal bleeding) in adults (Beyond the Basics)
Patient education: Blood in bowel movements (rectal bleeding) in babies and children (Beyond the Basics)
Patient education: Flexible sigmoidoscopy (Beyond the Basics)
Patient education: Colonoscopy (Beyond the Basics)
Patient education: High-fiber diet (Beyond the Basics)