An anal fissure is a small tear in the skin around the opening of your anus. It can cause severe pain and sometimes bleeding, usually after a bowel movement.
Anal fissures are usually found at the part of your anus closest to your back – in line with the cleft of your buttocks. A fissure can also sometimes occur at the front of your anus.
An anal fissure usually heals within two to four weeks. This is known as an acute anal fissure. The term ‘acute’ refers to how long a person has had it, not to how serious the condition is. If it lasts for longer than six weeks, it’s known as a chronic anal fissure.
Although an anal fissure can occur at any age, it’s most common in people aged 15 to 40.
An anal fissure can sometimes be confused with piles (haemorrhoids) because symptoms can be similar. If you have an anal fissure, you may have:
After having a bowel movement, you may notice a streak of blood on the toilet paper or drops of blood in the toilet bowl.
These symptoms may be caused by something other than an anal fissure. But if you have any of these symptoms, see your GP.
The main complication of an anal fissure is that it may take a while to heal, resulting in a chronic fissure. This can happen if:
The more you strain when having a bowel movement, the less likely it is that the tear will heal.
There are a number of reasons why you may develop an anal fissure. These include:
Your GP will ask about your symptoms. They may examine the area by parting your buttocks as you lie on your side with your knees bent towards your chest. If your GP can see the fissure, they will discuss your treatment options with you.
If after about six weeks your symptoms haven’t improved with treatment, your GP may refer you to a colorectal surgeon. This is a surgeon who specialises in conditions that affect the bowel. At the hospital, your doctor will do a detailed examination under local anaesthesia. A local anaesthesia blocks pain from your anus and surrounding area, but you will stay awake during the procedure. You may also need to have an ultrasound scan of your anus.
To help an anal fissure heal, it’s important not to strain during a bowel movement and manage any pain caused by the fissure. Most anal fissures heal with changes to your diet and the right medicines. However, if the anal fissure doesn’t get better, you may need to have surgery.
Making changes to your diet and lifestyle can help prevent constipation and make your faeces softer, and therefore easier to pass. You can do this by:
It may help to apply a lubricant, such as petroleum jelly, around your anus before you have a bowel movement. Sitting in a warm bath for 10 to 15 minutes after a bowel movement may also help relieve any discomfort.
Your GP may prescribe you a laxative, such as lactulose syrup, to soften your faeces. You can buy laxatives over the counter from a pharmacist without a prescription. However, it’s important to see your GP before trying laxatives because there are different types that work in different ways.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen.
Your GP may prescribe you the following medicines to relieve the spasm of an anal fissure.
Easing the anal spasm can help the fissure heal over a period of about four to six weeks. However, these treatments may not provide complete relief from your symptoms and you may need to use them with painkillers. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.
Botulinum A toxin (eg, Botox) is now being used more and more by surgeons. In this procedure, your surgeon injects botulinum A toxin into the internal sphincter muscle to help it relax. If a sentinel pile is present, your surgeon may remove it during the procedure to help aid healing. The effects of the treatment last around three months, by which time it's hoped the fissure will have healed. Like calcium-channel blockers, the use of botulinum A toxin is off-label.
If treatment with botulinum A toxin doesn’t work, your surgeon may suggest that you have a procedure called lateral internal sphincterotomy. During this procedure, your surgeon makes a small cut in the internal sphincter muscle to stop it from going into spasm. This means you will strain less when you go to the toilet and therefore less stress is put on the fissure, giving it time to heal. The procedure is usually done under general anaesthesia, which means you’ll be asleep during the operation.
As with any operation, there are possible complications associated with lateral internal sphincterotomy. Your doctor will talk to you about any that may apply to you so you’re fully informed before you go ahead with the surgery. Speak to your doctor for more information about treatments for anal fissure.
You can reduce your risk of developing an anal fissure by preventing constipation. This is particularly important if you’ve had an anal fissure in the past. You can prevent constipation by eating a balanced diet rich in fibre, fruit and vegetables, drinking enough fluids and exercising regularly.
If you have a condition that increases your risk of having an anal fissure, speak to your doctor. They will discuss with you how to best manage your condition and reduce your risk of having an anal fissure.
Reviewed by Alice Rossiter, Bupa Health Information Team, August 2014.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
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