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A tear in tissues that line the anus is called an anal fissure.

Often aggravated by difficult bowel movements or constipation, fissures in the anal area are usually a minor inconvenience requiring little or no treatment. While more common in younger children, anal fissures can affect anyone.

  • If these tears become a recurring problem or contribute to an infection and other issues, you may be referred to a hemorrhoid specialist.
  • Treatment typically involves lifestyle changes, medication, and home remedies that promote tissue healing, such as sitz baths.

Causes and Symptoms

Anal fissures may suddenly develop following attempts to pass a hard or large bowel movement. Chronic constipation and diarrhea can also contribute to the development of anal tears. Some women experience fissures as a result of childbirth. Other contributing factors include inflammatory bowel disease (IBD). It's also possible to develop anal fissures as a result of anal cancer and conditions such as herpes and syphilis, although this isn't common. Signs and symptoms related to anal tears include:

  • Noticeable pain during or after bowel movements
  • Blood that appears in stool or on toilet paper
  • Anal itching or irritation
  • Visible skin cracks or lumps in the affected area
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Anal Fissure Diagnosis

Following a physical exam, diagnosis of anal fissures usually involves a digital rectal exam (DRE) or the use of a lighted scope (anoscope) to view the affected area. The location of anal fissures often suggests what may be causing the problem. Fissures on the side of the anal opening, for instance, may be related to conditions such as Crohn's disease. If a patient is at risk of other conditions that may contribute to fissures, other tests, like a colonoscopy, may be done. This is more likely to be the case with older patients.

Non-Surgical Treatments

If symptoms are mild, stool softeners are often among the first attempts at treatment recommended. The chronic constipation that can make it difficult for fissures to heal may also be managed by drinking more water and getting regular exercise to increase circulation to help damaged tissues heal. Patients may also notice improvements with daily warm baths that can help relax tissues and structures like the anal sphincter to encourage healing. Topical creams sometimes provide a more direct form of relief. Recurring anal fissures might be treated with injections of Botox (botulinum toxin type A) or certain blood pressure medications to relax the sphincter.

Surgery for Anal Fissures

While rarely necessary, surgery for anal fissures is sometimes recommended if other treatment attempts aren't preventing recurrence or easing discomfort. The most common procedure performed is a lateral internal sphincterotomy. During this surgery, part of the anal sphincter is removed to minimize muscle spasms and provide room for irritated tissues to fully heal. Most patients who reach a point where surgery is needed respond well to to the procedure.

The most effective way to reduce your odds of experiencing anal fissures is to avoid hard bowel movements as much as possible. If you have regular issues with constipation, you may benefit from a healthy diet that includes more fiber and plant-based foods like whole grains and fruits and vegetables. Pelvic floor and Kegel exercises are sometimes helpful.

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