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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Anal fissure

Last reviewed: July 9, 2012.

An anal fissure is a small split or tear in the thin moist tissue (mucosa) lining the lower rectum (anus).

Causes, incidence, and risk factors

Anal fissures are very common in young infants, but may occur at any age. The rate of anal fissures drops with age. Fissures are much less common among school-aged children than infants.

In adults, fissures may be caused by passing large, hard stools, or by having diarrhea for a long time. Other factors may include: 

Anal fissures are also common in women after childbirth and in persons with Crohn's disease.

Symptoms

Anal fissures may cause painful bowel movements and bleeding. There may be blood on the outside of the stool or on the toilet tissue (or baby wipes) after a bowel movement.

Symptoms may begin suddenly or develop slowly over time.

Other symptoms may include:

  • A crack in the skin that can be seen when the area is stretched slightly (the fissure is almost always in the middle)
  • Constipation

Signs and tests

The health care provider will perform a rectal exam and look at the rectal (anal) tissue.

Treatment

Most fissures heal on their own and do not need treatment.

To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently.

CHILDREN AND ADULTS

Worrying about pain during a bowel movement may cause a person to avoid them. But not having bowel movements will only cause the stools to become even harder, which can make anal fissure worse.

Prevent hard stools and constipation by:

  • Making diet changes -- eating more fiber or bulk, such as fruits, vegetables, and grains 
  • Increasing fluids
  • Using stool softeners

Applying the following ointments or creams to the area may soothe the skin:

  • Numbing cream, if pain interferes with normal bowel movements
  • Petroleum jelly
  • Zinc oxide, 1% hydrocortisone cream, Preparation H, and other products

A sitz bath is a warm water bath used for healing or cleansing. You should sit in the bath two to three times a day. The water should cover only your hips and buttocks.

If the anal fissues do not go away with home care methods, treatment may involve:

  • Botox injections into the muscle in the anus (anal sphincter)
  • Minor surgery to relax the anal muscle
  • Prescription creams applied over the fissure to help relax the muscles

Expectations (prognosis)

Anal fissures usually heal quickly without any more problems. Rarely, a fissure may not heal.

People who develop fissures are more likely to have them in the future.

References

  1. Danakas G. Anal fissure. In: Ferri FF, ed. Ferri's Clinical Advisor 2008: Instant Diagnosis and Treatment. 1st ed. Philadelphia, Pa: Mosby; 2008.
  2. Marcello PW. Diseases of the anorectum. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 125.

Review Date: 7/9/2012.

Reviewed by: Todd Eisner, MD, Private practice specializing in Gastroenterology, Boca Raton, FL. Clinical Instructor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Non surgical therapy for anal fissure.Non surgical therapy for anal fissure.
    Anal fissure is a painful ulcer usually occurring in the posterior midline of the skin just outside the entry to the rectum. Its persistence is due to spasm of the internal sphincter muscle. The typical pain of this condition is pain on moving one's bowels that persists for some time afterward. Relief with healing of chronic fissures until very recently has been achieved by surgical procedures aimed at ablation of the sphincter spasm. Because of the risk of incontinence resulting from surgery, medical alternatives for surgery have been sought. Among the older medications, bran is effective in preventing recurrence of acute fissure. Local application of muscle relaxing therapy is effective in healing chronic anal fissure, though not as well as surgery, and with considerable risk of adverse events during therapy. There is a Cochrane review related to this review dealing only with surgical procedures.
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