What is an Anal Fissure?

An anal fissure is tearing in the lining of the anus. It can cause pain, bleeding and/or itching.

What causes an anal fissure?

It is usually caused by a hard and dry bowel movement which tears the anal lining. Other causes include diarrhoea and inflammation of the anorectal area.

How can a fissure be treated?

At least 50 percent of fissures heal either by themselves without need for an operation. Application of special medicated cream, use of stool softeners, avoidance of constipation, and the use of sitz baths (soaking the anal area in plain warm water for 20 minutes, several times a day) help to relieve the symptoms and allow healing to occur.

For the more chronic fissure, glyceryl trinitrite ointment may be used to relax the sphincter muscles. This would then improve the blood flow to the lining and allow healing to occur. One of the more common side effects of the ointment is headache.

Why is it some fissures do not heal?

When healing starts after a tear, the area is not as healthy as normal lining. Another episode of hard stools will cause the healing area to tear again. Repeated tearing will results in the tear becoming deeper and deeper. When the muscles of the anus lying below the lining are exposed, the muscles go into spasm. This results in more pain, and as the muscle is tight, stronger force is required to push the stools through and this result in more tearing. In these cases, the relaxation induced by the glyceryl trinitrie ointment is inadequate to allow good blood flow for healing.

What if a fissure does not heal?

A fissure that does not heal should be re-examined to determine if an underlying problem that prevents healing exists. This could be due to scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding can be corrected by anal surgery.

How long does the healing process take after anal surgery?

Most patients can go home the same day. Complete healing occurs in a few weeks, although pain often disappears after a few days.

Will the problem return?

Most patients who had anal surgery for anal fissure have no further trouble after surgery.

Can fissures lead to colon cancer?

No! Persistent symptoms need careful evaluation, however, since conditions other than fissure can cause similar symptoms.