Anal Fissure, Symptoms, Cause, Treatment

What is an Anal Fissure?


An anal fissure is a small tear or cut in the skin lining of the anus. Anal fissures may be acute, meaning recent, or chronic, meaning present for a long time or recurring frequently.

What are Symptoms of an Anal Fissure?

Anal fissures can cause pain during bowel movements that can last hours. Red blood can also appear in the toilet or stool.  The pain can be so severe that some patients may try to avoid having a bowel movement. There are a great deal of nerves in this area which amplifies the pain of a fissure compared to its size.  The result of not wanting to have a bowel movement can lead to constipation adding to the problem.

What causes an Anal Fissure?

Generally speaking, an anal fissure is caused by trauma in the anus and anal canal. A hard, difficult bowel movement can cause a tear in the anal lining and create a fissure. Diarrhea or inflammation in the rectal area can also be a cause.  Some undigested foods such as corn chips or sunflower seeds can cause a tear in the anus, thus causing an anal fissure.

The majority of time a fissure will heal on its own. However, for some patients, a fissure never heals and becomes a sore that is constantly re-injured and torn. A chronic fissure can be due to poor bowel habits, scarring or another medical problem such as Crohn’s disease, sexually transmitted diseases or  human immunodeficiency virus (HIV).

The anal sphincter muscles are the muscle group that supports the anal canal. When they are working properly the sphincter muscles help have a bowel movement or prevent a bowel movement. The external anal sphincter is a voluntary muscle that can be controlled consciously. The internal anal sphincter is an involuntary muscle we cannot control. When it is working, the internal sphincter is constantly contracted and prevents small amounts of stool from leaking from the rectum. This is how incontinence happens.

How is a Fissure Treated?

Most acute fissures will heal without surgery and is managed with a high fiber diet, stool softeners and plenty of fluids to avoid constipation. Medicated ointments can help ease the painful muscle spasm and promote healing of the fissure.

A chronic fissure lasting more than a month may require additional treatment. A anal manometry test may be performed to determine if sphincter pressures are high. A physical exam under anesthesia may be recommended to determine why healing is not taking place.

What is done for a Fissure that doesn’t Heal?

Surgery may be required, which usually cuts a small portion of the internal anal sphincter muscle to reduce pain and spasms. It is usually an outpatient procedure that rarely interferes with controlling bowel movements. Complete healing usually takes a few weeks. Virtually all patients have no further problems after surgery.

You need to see a physician for any extreme pain or rectal bleeding as soon as possible.  We offer same day appointments.


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Dr. Abbadessa is board certified by the AOA and is a member of the Missouri Association Osteopathic Physicians and Surgeons
| St. Louis Metropolitan
Medical Society | Missouri State Medical Association

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