Anal Fissure

An anal fissure is a small tear in the thin, moist tissue that lines the anus. The anus is the opening at the end of the digestive tract where stool leaves the body. Anal fissures most often occur due to constipation, straining during bowel movements, or passing hard or large stools.

Anal fissures commonly cause pain and bleeding during bowel movements. Some people may also experience spasms in the anal sphincter, which is the ring-shaped muscle at the end of the anus that controls bowel movements. These spasms can slow healing and increase discomfort.

Anal fissures are very common in young infants but can affect people of any age. In most cases, anal fissures heal with simple treatments such as increasing fiber intake or soaking in warm water. Some people may need medication, and in a small number of cases, surgery may be required.

Symptoms

Symptoms of an anal fissure are usually noticeable and may include:

• Pain during bowel movements

• Pain after bowel movements that may last for several hours

• Bright red blood on the stool or toilet paper after a bowel movement

• A visible crack or tear in the skin around the anus

• A small lump or skin tag near the fissure

Causes

Anal fissures most commonly develop when the anal lining is stretched or injured. Common causes include:

• Passing large or hard stools

• Constipation and straining during bowel movements

• Long-lasting diarrhea

• Anal intercourse

• Childbirth

Less common causes include underlying medical conditions such as:

• Crohn’s disease or other inflammatory bowel diseases

• Anal cancer

• HIV infection

• Tuberculosis

• Syphilis

Risk factors

Certain factors can increase the risk of developing an anal fissure.

Constipation is a major risk factor, as straining and hard stools can tear the anal lining. Childbirth increases the risk, especially in women who experience strain during delivery.

Inflammatory bowel diseases, such as Crohn’s disease, can cause chronic inflammation that weakens the anal canal lining and makes it more prone to tearing. Anal intercourse may also increase risk.

Age plays a role as well. Anal fissures can occur at any age but are more common in infants and middle-aged adults.

Complications

Most anal fissures heal with proper care, but complications can occur in some cases.

A fissure that does not heal within eight weeks is considered chronic and may require additional treatment. Recurrence is also common, and people who have had one fissure are more likely to develop another.

In some cases, the tear can extend into the internal anal sphincter muscle. When this happens, healing becomes more difficult. A chronic fissure can lead to a cycle of pain and muscle spasm that may require medication or surgery to relieve symptoms and promote healing.

Prevention

Anal fissures may be prevented by reducing the risk of constipation and diarrhea. Eating a diet high in fiber, drinking plenty of fluids and exercising regularly can help maintain soft stools and regular bowel movements.

Avoiding straining during bowel movements and addressing digestive issues early may also help protect the anal lining and reduce the risk of developing an anal fissure.