An anal fissure is a tear in the anus. It can be small and clear up on its own, or because of its location, it can be painful and difficult to treat. Anal fissures are not as common as piles (hemorrhoids) but can affect as many as 1 in 10 people in their life.
People with anal symptoms may experience sharp pain when trying to poop, which can last several hours afterward. They can also get a small amount of bright red blood on the tissue or in the bowl.
The anal ring is a type of muscular mucosal tissue, much like the lips are. If you can imagine getting cracked lips in the cold, this can be painful but also difficult to mend as it’s a moist area.
Anal fissures are commonly caused by damage to the inner lining of the large intestine or the anal canal. It occurs mostly in constipated people, where large or hard poop causes the lining to stretch and tear. Anal sex can cause a similar trauma.
Other causes include inflammatory bowel conditions like Crohn’s disease or ulcerative colitis, sexually transmitted infections such as herpes, or persistent diarrhea that can irritate and then tear the lining. Fissures can occur during pregnancy or childbirth, but there is not always a clear cause for them.
There are several things you can do at home to prevent constipation. Drinking plenty of fluid, increasing the amount of fiber in your diet, and staying active are all important to encourage regular passage of stool.
The pain from a fissure can cause you to avoid toileting, but this can worsen the problem. Simple painkillers such as acetaminophen or ibuprofen can be bought from your local pharmacy. Soaking your bottom in a warm bath with Sitz salts may also be helpful to ease the discomfort.
It may help to apply Vaseline before passing stool to reduce pain and protect the fissure from further stretch or harmful gut bacteria.
If symptoms persist for more than 1 week if you are in severe pain or unsure of the diagnosis, or if you are getting repeated fissures, you should book an appointment with your doctor. Similarly, if you have specific concerns about why you've gotten a fissure, speak to your doctor.
They will ask about your symptoms to try and work out what might have caused them, and they will ask about any products you've tried at home. They will offer to examine your anus, where they may see the tear.
Hemorrhoids can also cause some pain and anal bleeding, so they may suggest an internal examination, inserting a gloved finger into your rectum to feel for this or other causes.
You can try simple over-the-counter painkillers such as ibuprofen or acetaminophen.
Symptoms of an anal fissure can be embarrassing for some. Still, it’s important to remember they are common, and your pharmacist or doctor can help, so don’t avoid seeing them if you are bothered by the symptoms, and they are not improving with time.
Your doctor can prescribe laxatives to soften your stool so you can toilet without straining. They may offer more potent painkillers in the form of tablets or creams.
An anesthetic ointment such as lidocaine 5% can be helpful to use for a few days to numb the area before passing a stool. Applying nitroglycerin ointment can help to aid healing and can be continued for 6 to 8 weeks. It should be avoided in children, pregnancy, or breastfeeding.
If your doctor is concerned that something more concerning is causing the fissure, they will refer you to a specialist for review. The specialist will examine you properly using anesthesia and may use a long thin tube with a camera to visualize higher into your canal. Surgery may be recommended in persistent or chronic cases.
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