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Anal Fissure

An anal fissure is a tear in the lining of the lower rectum (anal canal). This tear causes pain during bowel movements, but usually don’t lead to more serious problems.

Most anal fissures (short-term (acute) anal fissures) heal with home treatment after a few days or weeks, and if you have an anal fissure that hasn’t healed after 8 to 12 weeks, it is considered a long-term (chronic) fissure, which may need medical treatment.

Anal fissures are common problems that affect people of all ages, especially young people.

Trauma or injury can stretch the anal canal and create a tear in the lining of the anus, usually from passing large or hard stools.

Anal fissures are very common in young infants, and most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Sometimes, some people with anal fissures may need surgery.


Symptoms of an anal fissure include:

  • Pain during bowel movements
  • Pain after bowel movements that can last up to several hours
  • Bright red blood on the stool or toilet paper after a bowel movement
  • Itching or irritation around the anus
  • A visible fissure in the skin around the anus
  • A small skin tag on the skin near the anal fissure

What Causes Anal Fissures?

Most anal fissures are caused by trauma to the anal area, mainly from passing a strong or large stool during a bowel movement. Other causes include:

  • constipation
  • diarrhea
  • anal injuries
  • Crohn’s disease.
  • pregnancy
  • childbirth

There are also other less common causes, such as:

  • cancer
  • HIV
  • tuberculosis
  • Sexually transmitted infections (STIs), like genital herpes.
  • syphilis

Risk Factors

Factors that may increase your risk of developing an anal fissure include:

  • Infancy
  • Aging, partly due to slowed circulation, resulting in decreased blood flow to the rectal area.
  • Constipation, since straining during bowel movements and passing hard stools increase the risk of tearing.
  • Childbirth
  • Crohn’s disease, which is an inflammatory bowel disease that causes chronic inflammation of the intestinal tract, making the lining of the anal canal more vulnerable to tearing.
  • Anal intercourse.

Complications of anal fissure may include failure to heal, and recurrence. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment, and once you’ve experienced an anal fissure, you are prone to having another one.

Sometimes, an anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal, which can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair the fissure.

Treatment And Self-Care

There are different approaches to treatment, and that may include conservative treatment, botox, and surgery.

Conservative Treatment

This type usually works, taking 1-2 months, and involves:

  • eating lots of high-fiber foods
  • drinking lots of water to create soft stools, which will ease the pain and muscle spasm around the anus
  • having warm baths and
  • applying a muscle relaxant cream (such as 0.2% glyceryl trinitrate) to the area
  • Taking pain relief medication such as paracetamol.

Botox Treatment

Botox is a chemical that is injected into the muscles around the anus to help them relax, which allows the fissure to heal. Botox usually lasts for 2-3 months.


The surgery (sphincterotomy) involves a small cut being made into the sphincter muscle to relieve tension. It is usually a day procedure.

Self Care

  • Stays hydrated and drink plenty of caffeine-free fluids throughout the day. Much alcohol and caffeine can lead to dehydration.
  • Eat a fiber-rich diet to avoid constipation. You can gradually increase the amount of fiber you eat by having more wheat bran, Oat Bran, Peas and beans, citrus fruits, Prunes and prune juice, and whole grains, including brown rice, oatmeal, and whole-grain pasta, cereals, and bread
  • Try fiber supplements (if you can’t get enough fiber from food), to help soften stools and make you more regular. To avoid gas and cramping, gradually raise the amount of any fiber supplement you take until you reach the recommended dose.
  • Over-the-counter laxatives may help if adding more fiber to your diet does not. However, ask your doctor before taking any laxatives
  • Don’t ignore your urge to poop, since putting off bowel movements for later can lead to constipation, and stools may become harder to pass. You can end up causing pain and tearing.
  • Don’t strain or sit on the toilet too long, as this can increase pressure in the anal canal.
  • Gently clean and dry your anal area after each bowel movement, and avoid irritants to the skin, such as scented soaps or bubble baths.
  • Get immediate treatment for chronic constipation or diarrhea.
  • Sitz baths can promote healing of an anal fissure, and you can do that by soaking the rectal area in a tub of warm water, two or three times a day for 10 to 15 minutes.

You may be able to prevent an anal fissure by taking measures to prevent constipation, i.e Eat high-fiber foods, drink fluids and exercise regularly to stay fit.



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