A tiny tear in the moist tissue (mucosa membrane) lining up the anus is called an anal fissure. Passing hard or large stools during bowel movements is a common cause of an anal fissure. A fissure in the anal area typically causes pain and bleeding during bowel movements. People may also suffer from spasms in the anal sphincter, a muscular ring located at the end of your anus.

Young infants are more likely to suffer anal fissures, but they can occur at any age. Most fissures around the anal cavity tend to heal with simple treatment methods, like taking more fibre rich food or taking a sitz bath. In some cases, anal fissures are treated with surgery, which is a permanent solution.

Causes of Anal Fissures

Injury to the anus or anal canal can result in fissures. The injury might happen for any of the reasons mentioned below:

  • Chronic constipation
  • Passing large hard or dry stool strains your anus, which eventually results in fissures
  • Prolonged or chronic diarrhoea
  • Anal sex and anal stretching
  • Inserting foreign objects into the anus
  • Childbirth

Less common causes of anal fissures

Fissures in the anal region can also be caused by:

  • Underlying medical conditions like Crohn’s disease or any other IBD (inflammatory bowel disease)
  • Anal cancer
  • Sexually transmitted diseases like HIV, Syphilis etc.
  • Infectious diseases like Tuberculosis

Symptoms of Anal Fissures

  • You may feel pain before and after bowel movements
  • Constipation
  • The outer surface of the stool may be covered with blood
  • Wipes or toilet tissue smeared with blood
  • A visible tear in the anal canal
  • Itching and burning sensations associated with pain
  • Discomfort during urination
  • Frequent urination
  • Foul-smelling discharge

Anal Fissures Treatment

The treatment options for anal fissures include both medication and surgery to treat. The main goal of treatment is to ease discomfort and bleeding by reducing the pressure on the anal canal in all possible ways.   of mild fissures, conservative treatments may be tried first. 

  • Taking measures to prevent constipation 
  • Soaking in a warm bath (sitz bath) for 10 to 20 minutes 
  • Gently cleaning the anorectal area
  • Don’t sit on the toilet for too long or strain yourself
  • Lubricating the anorectal area with petroleum jelly.

These simple techniques can heal 80 to 90% of fissures within a few weeks to months. However, if anal fissures fail to heal or return after treatment, other measures may be necessary, such as:

  • Nitrate ointments
  • Topical anaesthetic creams
  • Calcium channel blockers
  • Botox injections

Surgery for Anal Fissures

In cases of chronic anal fissures that don’t respond to other treatment alternatives, or if you experience severe symptoms, a surgical procedure might be recommended. Lateral internal sphincterotomy (LIS) is a common surgical procedure used to treat anal fissures. During this procedure, a small portion of a section from the anal sphincter tissues is removed to relieve pain and spasm and promote healing.

Surgical treatment for chronic fissures has been shown to be more effective than any other form of medical treatment. For more detailed information consult Dr. Karunakar Reddy, Gastroenterologist at Matrusri Hospital, Hyderabad.