Anal Fissure

An anal fissure is a small tear in the lining of the anus. It commonly causes sharp pain during bowel movements, burning, and bright red bleeding on the toilet paper or stool.

Anal fissures are very common and are often caused by trauma to the anal canal, especially from passing hard stools or repeated irritation. Many fissures improve with conservative treatment, but some become chronic and require medical or surgical management.

Dr. Aisha Akhtar, a board-certified colorectal surgeon in Phoenix, specializes in diagnosing and treating anal fissures and other conditions affecting the colon, rectum, and anus.

What Is an Anal Fissure?

An anal fissure is a split or tear in the thin tissue that lines the anal canal. The tear may expose the underlying muscle, which can lead to pain, spasm, and poor healing.

Anal fissures are often confused with hemorrhoids because both can cause rectal bleeding and discomfort, but they are different conditions and may require different treatment approaches.

Types of Anal Fissures

Anal fissures are generally classified as acute or chronic.

Acute Anal Fissure

An acute fissure is a new tear that has been present for a short time. These fissures often heal with non-surgical treatment.

Symptoms may include:

• Sharp pain during bowel movements
• Burning or stinging afterward
• Small amounts of bright red bleeding
• Fear of passing stool because of pain

Chronic Anal Fissure

A chronic fissure is one that does not heal and may remain present for several weeks or longer. Chronic fissures may develop scar tissue and are more likely to require procedural treatment.

Features of a chronic fissure may include:

• Persistent pain with bowel movements
• Recurrent tearing
• Visible skin tag near the fissure
• Exposed internal sphincter muscle
• Ongoing bleeding or irritation

Common Symptoms of Anal Fissure

Symptoms of an anal fissure often include:

• Sharp pain during bowel movements
• Burning pain that may last after a bowel movement
• Bright red blood on toilet paper or stool
• A small tear near the anus
• Spasm or tightness in the anal area
• A small lump or skin tag near the fissure in chronic cases

Learn more:

• Rectal Bleeding

What Causes an Anal Fissure?

Anal fissures usually develop when the anal lining is stretched or injured.

Common contributing factors include:

• Constipation
• Passing hard or large stools
• Repeated straining
• Chronic diarrhea
• Childbirth
• Anal trauma
• Increased anal sphincter tone
• Inflammatory bowel disease in some cases

The pain caused by a fissure can lead to muscle spasm, which may reduce blood flow and make healing more difficult.

Acute vs Chronic Anal Fissure

How Is an Anal Fissure Diagnosed?

Diagnosis usually involves a medical evaluation that may include:

• Medical history review
• Physical examination
• Gentle inspection of the anal area
• Additional testing if symptoms suggest another condition

In many cases, the fissure can be identified during examination. Further evaluation may be recommended if symptoms are atypical or if other anorectal conditions need to be ruled out.

These evaluations help distinguish anal fissures from:

• Hemorrhoids
• Anal abscess
• Fistula
• Crohn’s disease
• Other causes of rectal bleeding

Treatment Options for Anal Fissure

Treatment depends on whether the fissure is acute or chronic and how severe the symptoms are.

Conservative Treatment

Many anal fissures improve with non-surgical care such as:

• Increasing dietary fiber
• Drinking more fluids
• Stool softeners
• Warm sitz baths
• Avoiding straining
• Avoiding prolonged sitting on the toilet

These measures help reduce trauma during bowel movements and support healing.

Medical Treatment

If symptoms persist, treatment may include prescription therapy aimed at reducing pain and relaxing the anal sphincter to improve blood flow and healing.

Medical treatment may include:

• Topical medications
• Pain control measures
• Targeted treatment for constipation or diarrhea

Surgical Treatment

For chronic fissures or fissures that do not respond to medical therapy, procedural or surgical treatment may be recommended.

Treatment options may include:

• Botulinum toxin injection
• Lateral Internal Sphincterotomy

Surgical treatment is usually considered when symptoms are persistent, severe, or recurrent.

When Should You See a Doctor?

You should seek medical evaluation if you experience:

• Severe pain with bowel movements
• Persistent rectal bleeding
• Symptoms lasting more than a few weeks
• Recurrent tearing
• A lump, drainage, or swelling near the anus
• Changes in bowel habits
• Symptoms that do not improve with home treatment

Rectal bleeding should always be evaluated to rule out other colorectal conditions.

Related Conditions and Treatments

You may also want to review:

• Hemorrhoids
• Rectal Bleeding
• Constipation
• Lateral Internal Sphincterotomy