Anal Fissures

What are anal fissures?

An anal fissure is a small crack or tear in the thin, moist lining of the lower rectum.

Symptoms of anal fissures

The most common symptom of an anal fissure is a shooting pain in the anal and surrounding area. Anal fissures often cause painful bowel movements and bleeding.

What causes anal fissures?

Anal fissures are usually a result of straining during a bowel movement, causing injury to the anal canal. They can also be caused by repeated diarrhea, when blood flow to the area is decreased (in older adults), after childbirth, or in people with Crohn’s disease.

How are anal fissures diagnosed?

Your doctor will perform a rectal exam. Usually, a visual exam is all that’s necessary to see the fissure. Your doctor might have to insert a lubricated, gloved finger into the anal canal.

Can anal fissures be prevented or avoided?

Keeping bowel movements regular and avoiding constipation can help. Add more fruits, vegetables, and whole grains to your daily plate to get enough fiber. Drink plenty of fluids and get some exercise in every day to help keep your digestive system moving.

Anal fissures treatment

About half of all fissures heal by themselves and need no treatment at all. If fissures don’t heal on their own, other treatments may involve prescription creams such as nitrates or calcium channel blockers. You may even need Botox injections into the muscle in the anus (called the anal sphincter). Minor surgery to relax the anal muscle can be used as a last resort.

Living with anal fissures

Your doctor may prescribe stool softeners to make going to the bathroom easier and less painful while the fissure heals. Numbing cream can also make bowel movements less painful. Petroleum jelly, zinc oxide, 1% hydrocortisone cream and products like Preparation H can help soothe the area. Instead of toilet paper, use alcohol-free baby wipes that are gentler on the area.
Sitz baths can help heal fissures and make you feel better. Fill the tub with enough lukewarm water to cover your hips and buttocks. Don’t use soap or bubbles or any other products unless prescribed by your doctor. Relax in the sitz bath 2 to 3 times a day for about 10 minutes at a time.
People who develop fissures once are more likely to have them in the future, so it’s important to keep bowel movements regular. If you’re worried about pain during a bowel movement, you might be tempted to hold it in. But that will only cause the stools to become harder, making the fissure worse. Continue with a high-fiber diet and plenty of liquids.

Questions to ask your doctor

• How can I add more fiber into my diet?
• Should I use laxatives?
• Should I use fiber supplements?
• What products do you recommend I use while I have the fissure?