Anal Fissures

What Are the Symptoms and Risk Factors of Anal Fissures?

Signs that you may have an anal fissure include:

• Pain with bowel movements
• Bleeding with bowel movements
• A tear or lump in the skin near the anus
• Spasms in the anal sphincter

A common cause is passing hard and large stool during a bowel movement. Both chronic constipation and diarrhea can also cause a fissure, as well as anal intercourse and childbirth.

Other risk factors include having:

• Crohn’s disease
• Anal cancer
• Syphilis
• HIV
• Tuberculosis

How Are Anal Fissures Diagnosed?

Our doctors will start by taking a full medical history and performing a physical examination of the anal area. Typically, a doctor can diagnose anal fissures through a simple visual examination. 

If the doctor believes further tests may help to determine an underlying condition, patients may undergo tests including:

• Colonoscopy, in which a lighted, flexible tube looks at the inner lining of the colon to check for inflammation
• Sigmoidoscopy, which is similar to a colonoscopy but looks at the just the rectum and lower part of the colon
• Anoscopy, in which a tube is inserted into the anus to look at the inside of the anus and rectum

How Are Anal Fissures Treated?

Generally non-surgical treatments will be recommended first, and many fissures can heal on their own with the proper self-care. Patients will be encouraged to drink fluids, eat high-fiber foods, and exercise regularly.

Patients should avoid straining during bowel movements, and long periods of sitting – both of which can increase pressure in the anal and rectal area. Warm tub baths can also speed up the healing process.

If the fissure doesn’t heal on its own, medications may also be prescribed. These may include topical anesthetic cream, nitroglycerin, and nifedipine ointment.

If those treatments don’t work, surgical treatment of anal fissures is considered.

What Does Surgery Involve?

For severe or chronic anal fissures that are not healing with medication, surgery is an effective option.

Our colorectal surgeons can perform a lateral internal sphincterotomy, which involves cutting a small portion of the anal sphincter muscle. This reduces spasms of the sphincter muscle and lessens the pain, and can help the area heal more effectively. 

Another way to fix anal fissures is perianal Botox injection. The effect lasts 3 to 6 months.