An anal fissure is a small tear of the thin tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools and they cause pain and bleeding. You may also 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 any age group. 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.
The main symptoms of a anal fissure include:
- Pain, sometimes severe, during bowel movements.
- Pain after bowel movements that can go up to several hours.
- Bright red blood in stools or the toilet paper after a bowel movement.
- Itching or irritation around the anus.
- A visible crack in the skin around the anus.
- A small lump on the skin near the anal fissure.
Common causes of anal fissure include:
- Passing large or hard stools.
- Constipation and straining during bowel movements.
- Chronic diarrhea.
- Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease.
Less common causes of anal fissures include:
- Anal cancer.
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.
- 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
Care and Treatment
You may be able to prevent an anal fissure by taking measures to prevent constipation. Eat high-fiber foods, drink fluids and exercise regularly.
When to Call the Doctor
When you have pain during bowel movements and after them or when you notice blood in your stools or toilet paper.