What are anal fissures?

Pain in the back isn’t always caused by hemorrhoids. If you experience anal pain and bleeding after a bowel movement, you may have an anal fissure. Think of anal fissures as ulcers in the large intestine – small, oval-shaped tears in the lining of the anal canal that can cause severe pain in the anus. The tears often heal on their own after a week or two, but if they don’t, they should be treated because they can significantly reduce your quality of life. 1,2,3,4

Symptoms of anal fissures

If you have an anal fissure, you may experience one or all of these symptoms: ⁵

A painful anus, especially during and after defecation
A visible tear or crack in the anus
Bleeding from the anus during or after defecation, usually bright red

Symptoms of anal fissures are similar to symptoms of hemorrhoids, so it is not uncommon for the two to be confused. What is different with anal fissures is that the anal pain is worse and can last for an hour after the last bowel movement. ⁶

Causes of anal fissures

When the inside of the anus or anal canal is stretched beyond normal, the skin sometimes becomes damaged. The damaged skin usually heals quickly on its own, but in some cases, cracks develop. Once a crack forms in the skin, passing stool becomes painful and the cramps in turn make it harder for the crack to heal. In one in four people with cracks, the condition becomes chronic, meaning it lasts for six weeks or more. ^7,8,9

In most cases, the lining of the anal canal tears from hard, dry stool caused by constipation. Doctors can’t always tell why some people develop fissures and others don’t, but muscle tone may play a role. The thicker the anal sphincter, the less blood can reach the wound, slowing healing. ¹⁰

Other causes of anal fissures include frequent diarrhea, inflammatory bowel disease, inflammation of the anal area, sexually transmitted diseases, and pregnancy and childbirth. About one in ten women develop anal fissures after vaginal childbirth. Anal fissures affect men and women equally and can occur at any age, even in young children. ¹¹

Treatment and further prevention

Many people are embarrassed about their symptoms of anal fissures and hesitate to seek help, but delaying treatment only makes the problem worse. Also, superficial fissures near the anal opening can often be easily treated at home.

In addition to medication, diet is crucial to preventing anal fissures. To prevent the fissures from getting worse, or even from forming in the first place, eat plenty of fruits, vegetables, and other fiber-rich foods that can help regulate your bowel movements. If diet alone isn’t enough to help you have regular bowel movements, you can try fiber supplements. ^{12, 2}

If you do not experience any improvement after 2-3 weeks of this treatment, contact a doctor to rule out other causes of your symptoms. If the fissures are chronic, your doctor may prescribe stronger medications to relax the sphincter; surgery is rarely necessary. ²

References

www.ncbi.nlm.nih.gov/pmc/articles/PMC3342598/ 2020-10-16
fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information 2020-10-16
Psychometric properties of a questionnaire (HEMO-FISSQoL) to evaluate the burden associated with haemorrhoidal disease and anal fissures. Abramowitz, L. 2018.
patient.info/digestive-health/rectal-bleeding-blood-in-faeces/anal-fissure 2020-10-17
www.hopkinsmedicine.org/health/conditions-and-diseases/anal-fissures 2020-10-17
patient.info/digestive-health/rectal-bleeding-blood-in-faeces/anal-fissure 2020-10-17
www.hopkinsmedicine.org/health/conditions-and-diseases/anal-fissures 2020-10-17
patient.info/digestive-health/rectal-bleeding-blood-in-faeces/anal-fissure 2020-10-17
www.nice.org.uk/advice/esuom3/ifp/chapter/what-is-a-chronic-anal-fissure 2020-10-17
patient.info/digestive-health/rectal-bleeding-blood-in-faeces/anal-fissure 2020-10-17
patient.info/digestive-health/rectal-bleeding-blood-in-faeces/anal-fissure 2020-10-17
www.hopkinsmedicine.org/health/conditions-and-diseases/anal-fissures 2020-10-17