An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).
Anal fissures are very common in young infants but can affect people of any age. An anal fissure usually heals on its own within four to six weeks. If it doesn't, medical treatment or surgery usually can relieve discomfort.
SYMPTOMS
Signs and symptoms of an anal fissure include:
Pain, sometimes severe, during bowel movements Pain after bowel movements that can last up to several hoursBright red blood on the stool or toilet paper after a bowel movementItching or irritation around the anusA visible crack in the skin around the anusA small lump or skin tag on the skin near the anal fissure
When to see a doctor
See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.
CAUSES
Common causes of anal fissure include:
Passing large or hard stoolsConstipation and straining during bowel movementsChronic diarrheaInflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease Childbirth
Less common causes of anal fissures include:
Anal cancerHIVTuberculosisSyphilisHerpes
RISK FACTORS
Factors that may increase your risk of developing an anal fissure include:
Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why.Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area.Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing.Childbirth. Anal fissures are more common in women after they give birth.Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing.
COMPLICATIONS
Complications of anal fissure can include:
Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment.Recurrence. Once you've experienced an anal fissure, you are prone to having another one.A tear that extends to surrounding muscles. 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. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure
PREPARING FOR YOUR APPOINTMENT
If you have an anal fissure, you may be referred to a doctor who specializes in digestive diseases (gastroenterologist) or a colon and rectal surgeon.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Write down any symptoms you're experiencing.Write down questions to ask your doctor.
Questions to ask your doctor
Some basic questions to ask your doctor include:
What is likely causing my symptoms?Are there any other possible causes for my symptoms?Do I need any tests?Is my condition likely temporary (acute) or chronic?What treatments do you recommend?Are there any dietary suggestions I should follow?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor may ask:
When did you begin experiencing symptoms?Have your symptoms been continuous or occasional?How severe are your symptoms?Where do you feel your symptoms the most?What, if anything, seems to improve your symptoms?What, if anything, seems to worsen your symptoms?Do you have any other medical conditions, such as Crohn's disease?Do you have problems with constipation?
What you can do in the meantime
While you're waiting to see your doctor, take steps to avoid constipation, such as drinking plenty of water