An anal fissure is defined as a small tear of the skin around the back passage (anus). An anal fissure that lasts more than six weeks is called a chronic anal fissure.
It may not be an issue you make a habit of discussing with your friends, but lots of us get to learn about anal tears (fissures) the hard way. They're not usually serious but they are most definitely painful! For most people, the anal fissure gets better quite quickly but some form of treatment is often needed and anal fissures may keep coming back.
How common are anal fissures?
Anal tears (fissures) are common and probably affect about 1 in 350 people each year. They are more common in people aged between 15 and 40 years but can occur at any age, including in very young children. Women who are pregnant or have recently had a baby are at higher risk of anal fissures, while they are much less common in the elderly.
What causes it?
When you pass hard stools (faeces), it stretches the edge of your back passage (anus). Some people have a tighter muscle band around the anus, so are more prone to developing a fissure. Being constipated, giving birth and sometimes having diarrhoea are also risk factors.
Less often, anal fissure can be a complication of Crohn's disease or an anal herpes infection.
Read more about what causes an anal fissure.
What are the symptoms?
An anal tear (fissure) causes pain around the back passage (anus). The pain can be really bad and tends to be worse when you pass stools (faeces) and for an hour or so after passing stools. You may also get some bleeding when you pass stools - usually bright red, in the pan or on the toilet paper. Bleeding from the back passage should always be checked by a doctor. In most people, the fissure heals within 1-2 weeks or so but it can take much longer.
How is it diagnosed?
Your doctor will usually diagnose an anal tear (fissure) by your typical symptoms and by examining the skin around your back passage (anus). No other tests are usually needed but your doctor may arrange some other tests just to check your gut (bowel) and back passage are otherwise okay.
What are the treatment options?
The aim is to ease the pain and to keep the stools (faeces) soft whilst the tear (fissure) heals. Fibre, fluid and medicines called laxatives can all help. Avoiding constipation will also help avoid the same problem in the future. Some creams and ointments can also help to relieve the pain.
If the anal fissure doesn't heal or keeps coming back you may need to see a specialist. They may discuss surgery or having a botulinum toxin injection.
Find out more about treatment options for an anal fissure.
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Further reading & references
- Anal Fissure; NICE CKS, July 2016 (UK access only)
- Brown CJ, Dubreuil D, Santoro L, et al; Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial. Dis Colon Rectum. 2007 Apr 50(4):442-8.
- Mentes BB, Tezcaner T, Yilmaz U, et al; Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum. 2006 Jul 49(7):1045-51.
- Nelson RL, Thomas K, Morgan J, et al; Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012 Feb 15 2:CD003431. doi: 10.1002/14651858.CD003431.pub3.
- Yiannakopoulou E; Botulinum toxin and anal fissure: efficacy and safety systematic review. Int J Colorectal Dis. 2012 Jan 27(1):1-9. doi: 10.1007/s00384-011-1286-5. Epub 2011 Aug 6.
- Samim M, Twigt B, Stoker L, et al; Topical diltiazem cream versus botulinum toxin a for the treatment of chronic anal fissure: a double-blind randomized clinical trial. Ann Surg. 2012 Jan 255(1):18-22. doi: 10.1097/SLA.0b013e318225178a.
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