What is an anal fissure?

An anal fissure is a tear in the lining of your anus. These small cuts are often a result of passing very large or hard stools. Fissures can be quite painful. They may also bleed during and after you move your bowels. This condition is quite common in babies. But, it can happen to you at any age. Small tears can heal on their own. Others may need treatment from your doctor or surgery to heal.

Causes of an anal fissure

Passing a large or hard stool is the most common cause of anal fissure. But, it's not the only way you can get this condition. Some other causes of anal fissures include:

  • Childbirth
  • Dehydration
  • Lack of fiber in your diet
  • Constipation or prolonged diarrhea
  • Having tight muscles around your anus
  • Crohn's disease or other bowel diseases

Risks of an anal fissure

Anal fissures are most common during the first year of life. You're also more at risk for this condition as you age. As you get older, the blood moving around in your veins begins to slow. You have less blood flowing to your rectal area. Constipation – especially when it causes you to strain during bowel movements – puts you at risk for anal fissures. Anal intercourse can also stress the area. Other serious diseases can also raise your risk.These risks include:

  • Tuberculosis
  • Anal cancer
  • Syphilis
  • Herpes
  • HIV

Symptoms of an anal fissure

If you have an anal fissure, you may notice a sharp pain. It happens in or around your anus during bowel movements. You may notice blood when you wipe yourself. You might also see the blood in your stool. Other symptoms include:

  • Burning or itching of the anal area
  • A visible tear in the skin around your anus
  • Skin tags, or a small piece of skin, next to the tear

Diagnosis of an anal fissure

Many anal fissures heal on their own. However, it's important to visit your doctor when you see blood in your stool or experience pain around your anus. Your doctor can do a rectal exam. This helps them find fissure. They can also do tests to make sure you don't have a more serious health condition.

If your anal fissure hasn't healed within six weeks, it's more serious. You may need more treatment. Also, your doctor can see if the anal fissure is actually a tear in the muscles that hold your anus closed. This can make your tear much harder to heal. It may cause discomfort and pain. Even if there are no complications or more serious concerns, your doctor can advise you on how to prevent more anal fissures.

Treatments for an anal fissure

Acute anal fissures are common and usually heal on their own with self-care.

Self-care treatments may include:

  • Stay hydrated — drink plenty of non-caffeinated and alcohol-free liquids throughout the day
  • Eat a fiber-rich diet — your goal should be to get 20 to 35 grams of fiber every day
  • Don't ignore your urge to go — putting off bowel movements for later can lead to constipation
  • Sitz baths — soak your anal area in warm water for up to 15 minutes, a few times a day
  • Avoid irritants to the skin, such as scented soaps or bubble baths.

Other treatment measures include:

  • Hydrocortisone — containing suppositories, foams, or creams
  • Calcium channel blocker ointments — increases the blood flow to your anal canal 
  • Injecting Botox into the anal sphincter — temporarily freezes the muscle and promotes healing

Recovery from an anal fissure

Your symptoms should disappear within a week or two. If your symptoms aren't gone within two weeks of treatment, make an appointment with your doctor. They can help you figure out a different treatment to try. They may also want to discuss surgery.

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