Anal fissure: Causes, diagnosis and treatment

Anal fissure is a medical condition that can affect people of all ages, both men and women. Although not dangerous, the crack affects a lot of daily activities of the patient. To learn more about this annoying disease, let’s go to the article: “What is anal fissure and what causes it?”

What is anal fissure?

An anal fissure is a cut or tear in the lining of the anal canal. They can extend from the anal canal to the outside of the anus.

Most anal fissures are less than a centimeter in length. But because the anus is a very sensitive part of the body, pain in this area can be quite severe. Pain usually occurs during or after a bowel movement and is sometimes accompanied by blood in the stool.

see more: Anal pain: Hard to say!

Anal fissure symptoms

The main signs and symptoms of anal fissures include:

  • Pain: Severe pain during and especially after a bowel movement, lasting from a few minutes to several hours. This frightens many patients and may try to avoid defecation after the pain. Between bowel movements, the disease is usually asymptomatic.
  • Bleeding: Patients often notice bright red blood from the anus on the toilet paper or on the stool.
  • Itching: Constant or intermittent in the anal area.


Constipation and dry, hard bowel movements are the main causes of anal fissures. However, loose stools and diarrhea can also be the culprits.

Constipation is a common cause of anal fissures
Constipation is a common cause of anal fissures

Additionally, less common causes of anal fissures include:

  • Inflammatory conditions, such as Crohn’s disease, ulcerative colitis, etc.
  • Some anal infections such as syphilis, tuberculosis, HIV/AIDS, etc.
  • Anal cancer.
  • These diseases cause atypical midline fissures that are numerous, painless, or do not heal after appropriate treatment.

Diagnosing anal fissures

In young adults, the diagnosis can often be made after performing a thorough examination of the anus. If it is not visible to the naked eye, the doctor will try to apply gentle pressure on the entire area. When the patient has a fissure, pain occurs.

For the elderly, rectal endoscopy is often indicated additionally to rule out more serious diseases such as cancer, hemorrhoids, etc.

Non-surgical treatment

Most anal fissures do not require surgery. These measures will help resolve symptoms and are likely to heal more than half of acute fissures with virtually no side effects.

  • High-fiber diet: It’s most common to make stools softer with a high-fiber diet. Additionally, dietary fiber supplements and stool softeners can also be used to aid in the healing process. In addition, make sure your body always has the necessary amount of water.
  • Topical pain relief: For a persistent burning sensation after going to the bathroom, Tylenol (acetaminophen) or ibuprofen may help. Additionally, some people find that taking a warm bath helps them relax and relieve pain.
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For more chronic fissures, other prescription medications may be indicated. Your doctor will discuss the benefits and side effects of each of these medications with you.

  • Topical nitroglycerin: Works to speed wound healing by dilating blood vessels in the area. Effectiveness is seen in at least 50% of chronic cracks.
  • Calcium blockers: They were originally designed to lower blood pressure. However, it also works to relax the sphincter as well as increase blood flow to the affected area, accelerating healing.


Surgical options include injection of Botulinum toxin into the anal sphincter and internal sphincterotomy. The goal is to relax the anal sphincter, thereby reducing pain and allowing the fissure to heal.

In some special cases, sphincterotomy must be carefully considered, such as:

  • Patients with bowel incontinence.
  • Known anal sphincter injury (such as after obstetric trauma).
  • Diarrhea (eg, Crohn’s disease).

A thorough discussion with your doctor will help determine the most appropriate treatment.

Botulinum toxin (botox)

They are injected directly into the sphincter in the anus to relax the muscle and facilitate wound healing. Patients can perform the procedure and go home the same day. Efficacy is shown in about 50-80% of cases and a maximum recurrence of 40%. Patients who fail this method will undergo traditional sphincterotomy.

Surgery to remove the internal sphincter

This is a highly effective method and is often used to treat chronic anal fissures. Patients can also perform the procedure and go home the same day. Of most concern is the risk of mild to severe bowel incontinence after surgery. However, this risk can be resolved in a short period of time.

Are anal fissures preventable?

Here are some tips that you can refer to to help prevent anal fissures:

  • Eat a balanced diet with plenty of fiber. Ensure adequate fluid intake each day (Remember that water is the best fluid).
  • Don’t hold back from going to the bathroom – the longer you wait, the larger and harder the stools will become. When they finally pass through the anal canal, it’s easier for them to cause a fissure.
  • Avoid foods that are hard to digest, such as nuts and popcorn.
  • For vulnerable people, use a damp cloth or soft cotton pad to clean up after going to the toilet. Avoid rough or scented toilet paper.
  • Regular exercise can reduce the risk of constipation, which in turn is less likely to cause anal fissures. Make sure your body is not dehydrated during and after exercise.
  • Avoid straining and sitting on the toilet for a long time.
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Anal fissure It is a benign condition and usually resolves on its own without surgery. Patients can be treated at home with measures such as eating a lot of fiber, drinking enough water, .. But to do that, the most important thing is to get an accurate diagnosis. Because symptoms of the disease can also be a sign of another, more serious condition. Therefore, do not be subjective, visit your doctor if you have any suspicious signs!

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