Information From Your Health Care Provider

ANAL FISSURE

Basic information

Anal fissure is a laceration, tear, or crack in the anal canal. It can affect all age groups, including infants.

Sharp pain with passage of a hard or bulky stool. The pain may last up to an hour, and returns with the next bowel movement.
Pain when sitting on a hard surface.
Streaks of blood on the toilet paper, underwear, or diaper.
Itching around the rectum.
Refusal to have a bowel movement (in children).

The exact cause is unknown. Symptoms usually occur after the stretching of the anus from a large, hard stool.

Constipation or prolonged diarrhea.
Childbirth.
Inflammatory bowel disease (e.g., Crohn's disease).
Certain infections (e.g., HIV or tuberculosis), anal trauma, or low fiber diet may play a role.

Avoid constipation by:
- Drinking at least 8 glasses of water daily.
- Eating a diet high in fiber.
- Using stool softeners, if needed.
Don't strain when having a bowel movement.
Avoid anal trauma.

Most fissures heal on their own. Others can be treated successfully. Most infants and young children recover after the stool is softened.

Fissure may become chronic and fail to heal.

Your health care provider will do a physical exam of the anus and rectum to confirm the diagnosis. Other medical tests are usually not needed.
Treatment usually begins with self-care. Conservative therapy is safe, has few side effects, and is usually the first step in therapy. The next steps may involve prescribed topical drugs or botulinum injection, and surgery if needed.
Gently clean the anus with soap and water after each bowel movement.
To relieve muscle spasms and pain around the anus, apply a warm towel to the area.
Sitz baths also relieve pain. Use 8 inches of warm water in the bathtub, 2 or 3 times a day for 10 to 20 minutes.
Surgery may be needed in some cases. The options, and the risks and benefits will be discussed with you.

For minor discomfort, use nonprescription topical anesthetics, such as lidocaine gel.
Use stool softeners (e.g., docusate sodium or docusate calcium).
Topical nitroglycerin may be prescribed. It can cause headache in some patients.
Topical calcium channel blockers may be prescribed (e.g., diltiazem or nifedipine). An oral form of the drug is sometimes prescribed.
Botulinum toxin (Botox) injections may be prescribed to help relax the sphincter muscles.

No limits. Physical activity reduces constipation risk.

Eat a high-fiber diet and drink extra fluids to prevent constipation.