Anal Fissure or Anal Tear

Pelvis | - Others | Anal Fissure or Anal Tear (Disease)


Anal fissure is a tear or break in the anal canal’s skin. Anal fissures can be observed by bright red anal bleeding on the toilet paper and sometimes even in the toilet.

Anal fissures may cause painful bowel movements and bleeding. There may be blood on the outside of the stool or on the toilet tissue following a bowel movement. 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) and constipation. Bleeding in small amounts, itching (pruritus ani), and a malodorous discharge may occur due to the discharge of pus from the fissure. As previously mentioned, anal fissures commonly bleed in infants.

Causes and Risk factors

The most common cause of an anal fissure is the passage of a large, hard stool due to constipation, or by prolonged diarrhea. In older adults, anal fissures may be caused by decreased blood flow to the area. Anal fissures are caused by trauma to the anus and anal canal. During childbirth, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm. Occasionally, the insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland) can result in sufficient trauma to produce a fissure.

Diagnosis and Treatment

Investigations involve a rectal exam and a sample of the rectal tissue. Non-surgical treatments are recommended initially for acute and chronic anal fissures. These include topical nitroglycerin or calcium channel blockers, or injection of botulinum toxin into the anal sphincter. Other measures include warm sits baths, topical anesthetics, high-fiber diet and stool softeners.

Most short-term anal fissures can heal with home treatment in 4 to 6 weeks. Home treatment involves sitting in warm water (sitz bath) for 20 minutes 2 or 3 times a day, increasing fiber and fluids, using stool softeners or laxatives to have pain-free bowel movements. After 6 weeks it is considered long-term and may need additional treatment. ...