Overview and Treatment of Anal Fissures

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An anal fissure is a tear in the tissue lining the anal canal. Such a break can cause severe pain and result in bleeding when you have a bowel movement. You may see bright red blood in your toilet or on your toilet paper. Anal fissures are not uncommon and can occur at any age.

Anal fissures are categorized as either acute or chronic. Acute anal fissures tend to be superficial and heal relatively quickly, without need for medical intervention.

Chronic fissures are those that have not healed within six weeks. Chronic anal fissures tend to be deeper than those that are acute.

Note: Any sign of bleeding from the rectum or anus should be reported to your doctor for an accurate diagnosis.

Symptoms of Anal Fissures

Causes of Anal Fissures

Anal fissures are typically the result of some form of trauma to the anus. This trauma has been associated with a variety of causes, but most often is simply the result of a hard stool. Surprisingly, it is estimated that only a quarter of anal fissures are caused by constipation. (This is not a contradiction as it is possible to experience a hard stool without being constipated.)

The associated trauma to the anus can also be the result of diarrhea episodes.

Anal fissures are also thought to be more likely when there is excessive tension in the internal sphincter of the anus.

There are some health conditions that are thought to increase the risk of experiencing an anal fissure:

Prevention of Anal Fissures

The self-care tips for preventing anal fissures are similar to those for preventing hemorrhoids. Try to keep your stool soft by taking in plenty of dietary fiber and drinking lots of water.

Be sure to cleanse the area gently.

Treatment of Anal Fissures

If you are experiencing an anal fissure, you may find relief and encourage healing through the use of a sitz bath. Keeping your stool soft and being gentle when cleansing the area will also help. Don't try to avoid or postpone bowel movements - this will only serve to harden the stool and further exacerbate the problem.

Should your symptoms persist, make an appointment with your doctor. There are several medical treatments that are available:

  • Surgery - a procedure known as lateral internal sphincterotomy (LIS)
  • Medications - either topical or injected
  • Botox injections


Cheung, O. & Wald, A. "The management of pelvic floor disorders" Alimentary Pharmacology and Therapeutics 2004 19:481-495.

Greenwald, D. "Common Disorders of the Anus and Rectum: Hemorrhoids and Fissures" The American College of Gastroenterology Accessed May 4, 2016.

Mapel, D., Schum, M. & Von Worley, A. "The epidemiology and treatment of anal fissures in a population-based cohort" BMC Gastroenterology 2014 14:129.

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