Anal Fissures

May 29th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

The symptoms might sound familiar, but the cause might surprise you. You can have rectal pain, bleeding and itching but not from hemorrhoid problems. In some cases, the culprit might actually be an anal fissure.

What are Anal Fissures?

Anal fissures are small tears or cracks in the lining of your lower rectum or anus. This lining is called the mucosa.

What are the Symptoms of Anal Fissures?

The symptoms of anal fissure can include:

  • Pain during a bowel movement
  • Persistent pain after a bowel movement
  • Blood in your stool, in the toilet bowel or upon wiping after a bowel movement
  • Itching or irritation of the anus or around the anus
  • Cracks or tears of the skin around the anus

What Causes Anal Fissures? Who Gets Them?

Anal fissures are especially common in infants. This can be due to constipation or perhaps trauma to the anus with the infant is cleaned.

In adults, constipation or straining to pass large or hard stools is the most common cause of anal fissures. Chronic diarrhea can also be a cause. If a person has a problem with decreased blood flow to the anorectal area, then this could lead to problems as well. Also, tension in the anal sphincter muscles is associated with anal fissures.

Anal fissures are also common in persons with Crohn’s disease and in women after childbirth.

Some less common causes are:

  • Rectal cancer
  • HIV infection
  • Tuberculosis
  • Syphilis
  • Herpes

How are Anal Fissures Diagnosed?

Your doctor will first do an exam of the outer anal area. There might be a crack or tear visible that can help make the diagnosis. If nothing can be seen, your doctor might use a special device called an anoscope to see inside the rectum.

The location can help your physician tell whether or not the fissure is due to a more serious problem. For example, if the fissure is seen on the sides of the anus, then the cause could be related to Crohn’s disease.

How are Anal Fissures Treated?

Typically the treatment is aimed at relaxing the anal sphincter, allowing for the smoother passage of stool and the relief of pain.

Constipation is the most common cause of anal fissures in adults so treatment includes fiber supplements to allow for the formation of soft formed stools. Stiz baths can help reduce pain and sphincter spasm. You simply soak your bottom in a few inches of warm water two to three times a day and after bowel movements. A topical pain reliever or steroid cream might also be recommended.

In more resistant cases other treatments might be used such as:

  • Topical nitroglycerin ointment: This is especially useful to promote better circulation to the area. Headache is the main side effect.
  • Topical or oral diltiazem or nifedipine: These are blood pressure medications which help relax the sphincter and improve blood flow.
  • Botulinum toxin (botox) injections: Paralyzes the muscles of the anus to reduce spasm. Used if you have ongoing or chronic anal fissures.

If symptoms persist despite changes in diet and the use of medications, then surgery is the ultimate level of treatment. It is very effective, but surgery also carries some risk of fecal incontinence.


Anal fissures are very common. Like symptomatic hemorrhoids they can cause pain, bleeding and itching. The initial treatment is similar to that of symptomatic hemorrhoids, that is, fiber and sitz baths. If anal fissures persist then special medications or even surgery might be required.

Explore The H Doctor website. You will find many more articles and videos that give the best information available about hemorrhoid treatment and other important digestive health topics.

Have an outstanding day.


Leave a Reply