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Anal fissure

  • Definition
    • An anal fissure is a small split or tear in the thin moist tissue (mucosa) lining the lower rectum (anus).

  • Alternative Names
    • Fissure in ano; Anorectal fissure; Anal ulcer

  • Causes
    • Anal fissures are very common in infants, but they may occur at any age.

      In adults, fissures may be caused by passing large, hard stools, or having diarrhea for a long time. Other factors may include:

      • Decreased blood flow to the area
      • Too much tension in the sphincter muscles that control the anus

      The condition affects males and females equally. Anal fissures are also common in women after childbirth and in people with Crohn disease.

  • Symptoms
    • Anal fissures may cause painful bowel movements and bleeding. There may be blood on the outside of the stool or on the toilet paper (or baby wipes) after a bowel movement.

      Symptoms may begin suddenly or develop slowly over time.

      Other symptoms may include:

      • A crack in the anal skin that can be seen when the area is stretched slightly (the fissure is almost always in the middle)
      • Constipation
  • Exams and Tests
    • The health care provider will perform a rectal exam and look at the anal tissue. Other medical tests that may be done include:

      • Anoscopy -- examination of the anus, anal canal, and lower rectum
      • Sigmoidoscopy -- examination of the lower part of large intestine
      • Biopsy -- removal of rectal tissue for examination
      • Colonoscopy -- examination of the colon
  • Treatment
    • Most fissures heal on their own and do not need treatment.

      To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently.

      CHILDREN AND ADULTS

      Worrying about pain during a bowel movement may cause a person to avoid them. But not having bowel movements will only cause the stools to become even harder, which can make anal fissure worse.

      Prevent hard stools and constipation by:

      • Making dietary changes -- eating more fiber or bulk, such as fruits, vegetables, and grains
      • Drinking more fluids
      • Using stool softeners

      Ask your provider about the following ointments or creams to help soothe the affected skin:

      • Numbing cream, if pain interferes with normal bowel movements
      • Petroleum jelly
      • Zinc oxide, 1% hydrocortisone cream, Preparation H, and other products

      A sitz bath is a warm water bath used for healing or cleansing. Sit in the bath 2 to 3 times a day. The water should cover only the hips and buttocks.

      If the anal fissures do not go away with home care methods, treatment may involve:

      • Botox injections into the muscle in the anus (anal sphincter)
      • Minor surgery to relax the anal muscle
      • Prescription creams such as nitrates or calcium channel blockers, applied over the fissure to help relax the muscles
  • Outlook (Prognosis)
    • Anal fissures often heal quickly without any more problems.

      People who develop fissures once are more likely to have them in the future.

  • References
    • Abdelnaby A, Downs JM. Diseases of the anorectum. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 129.

      Kliegman RM, Stanton BF, St. Geme JW, Schor NF. Surgical conditions of anus and rectum. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 344.

      Merchea A, Larson DW. Anus. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 52.