Anal Fissure
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What is an anal fissure?
An anal fissure is a small tear in the tissue that lines the anus. While usually not serious, it can cause significant discomfort and bleeding during or after bowel movements. Because symptoms of an anal fissure can be similar to those of hemorrhoids and other conditions, an evaluation by our colorectal experts can help ensure an accurate diagnosis and appropriate treatment.
What are the symptoms of an anal fissure?
Common symptoms include:
- Sharp pain during or after a bowel movement
- Bright red blood on toilet paper or in the toilet
- A visible crack or tear near the anus
- Itching or irritation around the anal area
Because bowel movements may become painful, some people may avoid going to the bathroom, which can worsen constipation and delay healing.
What causes an anal fissure?
Anal fissures most commonly develop when the delicate tissue lining the anus is stretched or injured. Common causes include:
- Passing hard or large stools
- Chronic constipation
- Frequent diarrhea
- Straining during bowel movements
- Inflammatory conditions affecting the digestive tract
Fissures may be acute (recently developed) or chronic (lasting several weeks or recurring). Some chronic fissures may be associated with a small skin tag near the tear.
How can a fissure be treated?
Many anal fissures improve with conservative treatment. Your clinician may recommend:
- Increasing dietary fiber
- Drinking more water
- Using a fiber supplement or stool softener
- Taking warm sitz baths several times a day
- Avoiding straining during bowel movements
In some cases, prescription medications may be used to help relax the anal muscles and promote healing. If symptoms persist or the fissure becomes chronic, your specialist may recommend additional treatment options.
Can an anal fissure come back?
Yes. Even after healing, an anal fissure can recur, especially if constipation, straining, or hard bowel movements return. Maintaining healthy bowel habits, staying hydrated, and consuming adequate fiber may help reduce the likelihood of recurrence.
If symptoms return or persist, it is important to seek medical evaluation to identify any underlying causes.
What if my fissure doesn't heal?
If symptoms continue despite treatment, your clinician may recommend further evaluation. Ongoing fissures can be related to muscle spasms, scarring, chronic constipation, or other underlying conditions.
In some cases, symptoms that resemble an anal fissure may be caused by inflammatory bowel disease, infection, or other medical conditions. A thorough examination can help determine the cause and guide the most effective treatment plan.
When is surgery recommended for an anal fissure?
Surgery may be considered when an anal fissure does not heal with conservative treatment. One commonly performed procedure, called a lateral internal sphincterotomy, involves releasing a small portion of the internal anal sphincter muscle. This can reduce muscle spasms, relieve pain, and help the fissure heal.
If a skin tag is present and contributing to symptoms, it may also be addressed during the procedure.
Most procedures are performed in an outpatient setting, allowing you to return home the same day. As with any surgery, there are potential risks and benefits. Your colorectal surgeon will discuss these with you when working with you to develop a personalized treatment plan.
How long does recovery take after surgery?
Recovery varies from person to person. Many people notice an improvement in pain within a few days, while complete healing may take several weeks. Your care team will provide detailed recovery instructions and support throughout the healing process.