An anal fissure is a small tear in the lining of the anal canal. It often causes sharp or burning pain during a bowel movement and pain that can continue for minutes or hours afterward. A small amount of bright-red blood may appear on the toilet paper or stool. This page is retained for general education; anal fissure procedures are not a current Zadeh Surgical service.
What causes an anal fissure?
A hard, dry bowel movement is a common cause, but frequent loose stool or diarrhea can also injure the lining. The pain can trigger spasm of the inner anal muscle. That spasm reduces blood flow to the tear, which makes healing more difficult and can create a cycle of pain, tightening, and repeated injury.
A fissure that has been present for several weeks may become chronic and develop scar tissue or a small skin tag. Fissures that are multiple, off to one side, or slow to heal may point to another condition such as inflammatory bowel disease, an infection, or—less commonly—a tumor.
How is a fissure diagnosed?
The symptom pattern and a careful examination often identify the problem. Fissures are commonly mistaken for hemorrhoids, but treatment is different. Persistent pain, unusual fissure location, recurrent symptoms, or unexplained bleeding may require further testing to rule out another cause.
What treatments are tried first?
- Keeping stool soft and formed with fiber, fluids, and treatment of constipation or diarrhea
- Warm-water baths to relax the area and ease discomfort
- Short-term topical numbing medicine when appropriate
- Prescription ointments that relax the inner anal muscle and improve blood flow
Strong pain medicines that worsen constipation can make the cycle harder to break. A clinician should guide prescription treatment because some ointments can cause headache or lower blood pressure.
When are procedures considered?
A chronic fissure that does not heal with bowel-habit changes and prescription treatment may be treated with botulinum toxin injection or an operation called lateral internal sphincterotomy. Both approaches relax the tight inner muscle so the tear can heal.
Sphincterotomy is highly effective, but dividing part of the muscle can affect control of gas or stool in a small number of patients. Prior childbirth injury, existing leakage, previous anal surgery, and diarrheal conditions matter when choosing treatment. A colon and rectal surgeon may recommend a muscle-sparing alternative for selected patients.
Persistent anal pain or bleeding deserves an examination.
A fissure is common and treatable, but not every painful or bleeding anal condition is a fissure or hemorrhoid.
Can a fissure return?
Yes. Even after healing, another hard bowel movement or episode of diarrhea can reopen the area. Maintaining consistent bowel habits is an important part of reducing recurrence.