An anal fissure  is a small, tear in skin that lines the opening of the anus. Fissures typically cause severe pain and bleeding during bowel movements. Fissures are quite common and the symptoms may be confused with that of other GI tract issues like hemorrhoids.

Fissures are caused by trauma to the inner lining of the anus.  Hard and dry bowel movements typically create a fissure.  There are a few cases where diarrhea and loose stools have caused fissures as well.   After a bowel movement, severe anal pain may produce spasms interfering with blood flow to the area and impairing its healing. The next bowel movement will do the same and further the trauma.  This cycle will continue until a fissure is created.

Some inflammatory conditions, tumors or other anal infections may also cause a fissure.  They may come from one direct trauma or a series over time finally creating the tear. Chronic fissures are more difficult to treat, and generally have an external lump associated with the tear on the inside of the anal canal, called a sentinel pile or skin tag.

Symptoms of anal fissures

  • Typical symptoms include
  • Severe pain during a bowel movement
  • Pain continuing several minutes to hours after a bowel movement.
  • Bright red blood seen on the toilet paper or on the bowel movement.

There are generally no symptoms between bowel movement. Some patients may withhold defecation in fear of the pain or any further damage.

Treatment of fissures would include a diet consisting with high fiber or stool softeners.  Topical anesthetics and baths may also assist in the relaxation of anal muscles which can assist in the relaxation and healing of anal fissures.  There are also medications that can be taken to relax the anal sphincter muscles. One concern with this is many medications cause constipation which would be problematic for this situation and could cause just as much damage.  Fissures can easily reoccur once there has been a tear.

Patients suffering from persistent anal pain or have chronic constipation or other GI track issues should be examined..