Anal Fissure

What is an anal fissure?

An anal fissure is a small tear in the skin of the anus. The anus is the opening of the rectum where bowel movements (BMs) leave the body. Anal fissures are a fairly common problem.

How does it occur?

A tear may occur when you have:

• hard, dry bowel movements
• constipation
• hemorrhoids
• anal surgery
• inflammation of the rectum caused by intestinal problems such as Crohn's disease.

What are the symptoms?

Symptoms can include:

• pain during and after bowel movements
• spasm in the muscle at the opening of the anus, caused by irritation of the cut during a bowel movement
• bright red blood when you have a bowel movement, which you see on the BM, in the toilet water, or on toilet tissue you have used.

How is it diagnosed?

Your health care provider will ask about your symptoms and examine you. You may have a procedure called an anoscopy to confirm the diagnosis. For this procedure your provider uses an instrument with a light called an anoscope to examine the anus and lower part of the rectum.

Your health care provider may recommend other tests or procedures, such as a sigmoidoscopy, to learn more about the cause of the fissure.

How is it treated?

Your health care provider may recommend stool softeners, such as Haley's M-O, psyllium, Metamucil or Citrucel, or mineral oil. It also may help to drink lots of water and add more fiber to your diet.

For pain, your provider may recommend or prescribe use of pain-relieving cream or ointment for a few days. Soaking in a warm bath may also help to relieve pain.

In rare case for fissures that recur or do not heal, an internal anal sphincterotomy may be necessary. This surgical procedure stops the painful spasms that occur, allows for much easier bowel movements, and helps the tear to heal.

How long will the effects last?

An anal fissure usually heals by itself in a few days. If you have muscle spasms, it may take longer to heal.

How can I take care of myself?

Follow these guidelines to treat an anal fissure:

• Keep your bowel movements soft:
  • Follow your health care provider's instructions for taking stool-softening medications.
  • Drink plenty of water (up to eight 8-ounce glasses a day).
  • Add more fiber to your diet with whole-grain foods, bran, raw fruits and vegetables, psyllium (a natural mild laxative), or fiber products such as Metamucil or Citrucel.
• Soak in a warm bath to help relieve pain.

Contact your health care provider for advice if you are using pain-relieving creams or ointments for more than a few days. Many of these products cause allergic skin reactions and worsen your problem.

What can I do to help prevent anal fissures?

The best prevention for anal fissures is to keep your bowel movements soft and to maintain a healthy lower intestinal tract. This includes:

• drinking plenty of water
• eating foods high in fiber
• being physically active.