Anal Fissure – Symptoms, Diagnosis & Treatment

An anal fissure is a small tear in the lining of the anus. It can be caused by chronic constipation or diarrhea, but it can also happen after an injury to your anal area.

The pain associated with an anal fissure is often described as a sharp or burning sensation, which may worsen with bowel movements and when sitting on hard surfaces.

Anal fissures are typically treated with topical creams and ointments, but your doctor may recommend more invasive treatments, such as surgery if these don’t work.

What Causes an Anal Fissure?

Anal fissures are common, especially for people with hemorrhoids (swollen veins in the anus). Other causes of anal fissures include:

  • Constipation
  • Diarrhea
  • Chronic constipation or diarrhea
  • Heavy lifting
  • Pregnancy
  • Surgery on your bowels or anus

What are the Symptoms of an Anal Fissure?

The following is a list of symptoms that may indicate the presence of an anal fissure.

  • Pain and tenderness in the anal area
  • Bleeding from the rectum, which may occur when you pass stool
  • A feeling of having not completely emptied your bowels after defecating
  • A sensation that something is still inside your rectum after you have passed bowel movements

What are the Risk Factors for an Anal Fissure?

The risk factors for anal fissures include:

  • Diarrhea
  • Constipation
  • Straining during bowel movements
  • Pregnancy and childbirth
  • Anal intercourse
  • Contraction of HIV/AIDS or other sexually transmitted infections
  • Any history of trauma to the area
  • Inflammatory bowel disease
  • Crohn’s disease
  • Irritable bowel syndrome (IBS)
  • Gastroesophageal reflux disease (GERD)

What are the Complications of an Anal Fissure?

Anal fissures can be painful and lead to further complications if left untreated. Some of the complications include:

  • Painful defecation
  • Excessive bleeding
  • Fecal incontinence (involuntary leakage of solid or liquid stool)
  • Anal fistula
  • Anal abscess 

How is it Diagnosed?

Anal fissures are usually diagnosed by your healthcare provider examining the anus and rectum. During the exam, they may use a mirror to look at the inside of their rectum. To diagnose an anal fissure, your healthcare provider will likely ask questions about your symptoms and past medical history. They may also want to know if you have had this problem before. Your doctor may also perform other tests to ensure you do not have other conditions causing similar symptoms. Your doctor may use one or more of the following tests to diagnose an anal fissure:

Rectal Exam: This test allows your healthcare provider to check for any abnormalities in or around the rectum, such as swelling or irritation.

Anoscopy (Proctoscopy): An anoscope is a thin tube with a light on its tip that allows your healthcare provider to look at the lining of your anus and rectum using magnification. This test can help identify any tears or inflammation in these areas. Stool Test: Your stool sample can be tested for blood or other signs of infection.

Sigmoidoscopy (looking inside the lower part of the colon with a flexible tube called a sigmoidoscope) to check the causes of bleeding from an anal fissure.

Colonoscopy involves inserting a flexible tube into your rectum to inspect the entire colon.

How is it Treated?

With appropriate home treatment, anal fissures can often heal within a few weeks. Increase your intake of fiber and fluids to help keep your stool soft. Soak in warm water for 10 to 20 minutes several times a day, especially after bowel movements. This can aid in sphincter relaxation and healing. If your symptoms persist, you will almost certainly require additional treatment. 

Nonsurgical treatments 

Your doctor may advise you to do the following: 

Nitroglycerin is applied externally (Rectiv). This can promote healing by increasing blood flow to the fissure. It can also help to relax the anal sphincter. When other conservative measures fail, nitroglycerin is widely regarded as the treatment of choice. Headaches, which can be severe, are possible side effects. 

Pain relief may be provided by topical anesthetic creams such as lidocaine (Xylocaine). 

Injection of onabotulinumtoxinA (Botox) to paralyze the anal sphincter muscle and relax spasms. 

Blood pressure medications like nifedipine or diltiazem can help relax the anal sphincter. These medications are typically applied to the skin but can also be taken orally. However, when taken orally, the side effects can be more severe. These medications may be used when nitroglycerin is ineffective or causes significant side effects. 


If you have a chronic anal fissure that is not responding to other treatments, or if your symptoms are severe, your doctor may suggest surgery. A procedure known as lateral internal sphincterotomy is typically performed by doctors (LIS). A small portion of the anal sphincter muscle is cut during LIS. This technique may aid in the promotion of healing as well as the reduction of spasms and pain.

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