Overview

Diagnosis of Anal Fissure

Anal fissures are usually diagnosed through a medical history review and physical examination. Most fissures are visible on inspection of the anal region.

  • Acute fissures: Recent tears, often resembling a paper cut.

  • Chronic fissures: Deeper, long-lasting tears (lasting more than eight weeks), sometimes with internal or external tissue growths.

Location clues

  • Fissures on the sides of the anus may indicate an underlying condition, such as Crohn’s disease, prompting further evaluation.

Additional tests

  • Anoscopy: A tubular device inserted into the anus for closer inspection.

  • Flexible sigmoidoscopy: A thin, flexible tube with a camera examines the lower colon. Often recommended for people under 45 with no risk factors.

  • Colonoscopy: Examines the entire colon. Usually recommended for those over 45, with risk factors for colon cancer, or with other concerning symptoms.

Treatment of Anal Fissure

Most anal fissures heal within a few weeks with home care measures:

  • Increase fiber and fluid intake to soften stools.

  • Take warm sitz baths for 10–20 minutes several times a day, especially after bowel movements, to relax the anal sphincter and promote healing.

Nonsurgical Treatments

If symptoms persist, your healthcare professional may recommend:

  • Topical nitroglycerin (Rectiv): Increases blood flow and relaxes the anal sphincter. May cause headaches.

  • Topical anesthetic creams (e.g., lidocaine/Xylocaine): Relieve pain.

  • Botulinum toxin (Botox) injections: Paralyze sphincter muscle to reduce spasms.

  • Calcium channel blockers (nifedipine, diltiazem): Relax the sphincter. Can be applied topically or taken orally, though oral use may increase side effects.

Surgical Treatment

  • Lateral internal sphincterotomy (LIS): Surgery involves cutting a small portion of the anal sphincter to promote healing, reduce pain, and relax spasms.

  • Surgery is more effective than nonsurgical treatments for chronic fissures but carries a small risk of incontinence.

Key Takeaways

  • Anal fissures are typically diagnosed with a physical exam and patient history.

  • Acute fissures often heal with home care, including fiber, fluids, and warm baths.

  • Persistent or chronic fissures may require medications like nitroglycerin, Botox, or calcium channel blockers.

  • Surgery is the most effective option for chronic, treatment-resistant fissures.

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