Anal Fissure - Frequently Asked Questions

1. What is anal fissure?

Anal fissure is a painful crack or tear in the skin and membrane of the anal canal, usually in the midline of the anus. It is also usually less than a quarter of an inch deep into the anal canal.

See picture (Warning: graphic image)

2. What causes anal fissure?

Anal fissure is usually caused by over-stretching of the anal sphincter muscle. It can be caused:

• Pushing a hard, dry feces too hard or too long
• Chronic constipation
• Prolonged diarrhea
• Rough anal sex
• Insertion of foreign object into the anal canal
• Spastic or unusually tight sphincter muscles

Anal fissure is also common in women after childbirth and in those suffering from Crohn's disease.

Surprisingly, anal fissure is a very common condition in infants - approximately 80% of babies develop anal tear by the age of one!

Acute or deep fissure can occur suddenly because of trauma to the anus, whereas superficial chronic fissure can develop and worsen with bowel movements over a period of several months.

3. What are the symptoms of anal fissure?

The symptoms of anal fissure include:

• Pain during bowel movement, sometimes lasting hours afterwards
• Visible tear in or near the anus
• Blood on the surface of the stool
• Blood on the toilet paper
• Constipation

4. How do I prevent anal fissure?

To prevent anal fissure in infants, remember to change diapers frequently and avoid keeping the baby in wet diapers for prolonged period of time.

Other preventions of anal tear include:

• Avoiding constipation by eating high-fiber diets and/or taking stool softener
• Promptly treating diarrhea
• Lubricating the anal canal with petroleum jelly when passing hard, dry stool
• Avoiding irritating the anal canal
• Using soft, moist wipes to clean the anus after bowel movements
• Keeping the anus dry and clean

5. What can I expect from a doctor's examination for anal fissure?

Doctor's examination for anal fissure may include:

• A visual examination of the tear
• Anoscopy or examination using a small viewing instrument (anoscope) to see inside of the anal canal
• A manometry test to determine whether abnormally high anal sphincter pressure cause or contribute to the fissure

6. What are the treatments for anal fissure?

Fortunately, shallow or superficial fissure usually self-heal within a two to three weeks. To avoid irritating the tear during bowel movement, treatments for this type of fissure are similar to that of hemorrhoids, including:

• A diet high in fiber to aid bowel movement
• Stool softener
• Pain killer
• Sitz bath
• Suppositories containing anti-inflammatory agents & local anesthetics

Approximately 50% to 75% of superficial fissures do not require any further treatment.

Infant anal fissures usually self-heal and do not require anything else than maintaining good diaper hygiene.

Deep fissures, in which the tear cuts through to the sphincter muscles, may require surgical treatments. As suturing or sewing up tear do not work (instead, they can cause the fissure to widen), medical treatments focus on keeping the sphincter muscle relaxed, and reducing tension and spasm which keep the fissure from healing. These treatments include surgical procedures or fissurectomies, such as:

• Anal dilatation (stretching of the anal canal)
  
• Internal lateral sphincterotomy (cutting a portion of the anal sphincter)
  
  These surgical treatments are highly effective, with success rate of between 95% to 98%.

and medical treatments, such as:

• Nitroglycerin and nifedipine ointments
  These two ointments are applied to the anus to temporarily relax the sphincter muscles and increase blood flow to promote healing. Preliminary studies of these ointments are promising, with success rates of between 70% and 90%.
  
• Botulinum toxin injections
  For chronic fissures, botulinum toxins can be injected into the sphincter muscles.Side effects of these procedures are usually minimal,

7. What are the side effects of these treatments?

Surgeries to repair anal fissures typically do not require hospitalization and carry minimal recovery time. Normal activities can resume as soon as 24 hours after the procedure. However, these surgeries do carry risks, such as risks from local anesthesia and infections, as well as the remote possibilty of anal leakage or fecal incontinence.

8. Can an anal fissure lead to colon cancer?

No. Anal fissure does not turn into colon cancer. However, their symptoms are similar - so see your doctor immediately if you notice rectal bleeding of any amount.