Anal Fissures Management and Treatment

A tear within the lining of the anus or anal canal is known as anal fissure. The anal canal is an opening from which stool passes out of the body, but due to the fissure, it can be painful and may bleed.

Dr. Samrat Jankar Created on 22nd Feb, 21

Anal fissures can happen to anyone at any age. Yet, the chances of getting anal fissure decreases as people get older. Also, people who had fissures in the past are very likely to get them in the future.


What Causes an Anal Fissure?

You may suffer from an anal fissure if your anus and the anal canal have gone through a trauma. This trauma can be due to the following:

  • Chronic constipation
  • Straining to have a bowel movement
  • Prolonged diarrhea
  • Anal stretching. anal sex,
  • Inserting foreign objects into the anus

Other causes include:

  • Consistent poor bowel habits
  • Overly tight muscles that control the closing of the anus
  • Scarring in the anorectal area
  • Reduced blood flow to the anorectal area
  • An underlying medical problem, such as Crohn's disease, ulcerative colitis, anal cancer, leukemia, infectious diseases, and sexually transmitted diseases

Symptoms of an Anal Fissure

Symptoms of an anal fissure may include:

  • Pain during and after a bowel movement
  • Constipation
  • Blood on the surface of the stool
  • Blood on toilet tissue
  • A visible tear in the anus or anal canal
  • Burning and itching that is painful
  • Discomfort while urinating, continuous urination, or inability to urinate
  • Foul-smell in discharge
  • Anal fissures also occur in women after childbirth and young infants.


How are Anal Fissures Treated?

The main aim of anal fissure treatment is to reduce the pressure on your anal canal. You can achieve this by making stools soft to minimize discomfort and bleeding. Your doctor will start with regular treatments first and include the following:

  • Prevention of constipation with the help of stool softeners, drinking more water also avoiding caffeine which can cause dehydration
  • Dietary changes like increasing intake of high fiber foods and fiber supplements
  • Soaking in a warm bath also known as sitz bath 10 to 20 minutes a day helps by relaxing your anal muscles
  • Cleansing your anorectal area more gently
  • Avoiding prolonged sitting on the toilet or straining
  • Usage of petroleum jelly to lubricate the anorectal area

Following these practices will heal most fissures within several weeks to months.

However, if these treatments do not work and anal fissures come back, your doctor might suggest other measures. These are:

  • Using hydrocortisone-containing foams, suppositories, or creams will help reduce inflammation
  • Applying other creams and ointments. These may include
  • Medicated cream to help heal the fissure
  • Topical muscle relaxant to relax the anal muscles
  • Anesthetic ointment to reduce pain, if pain interferes with a bowel movement
  • Calcium channel blocker ointments that relax the anal muscles and increase blood flow to the region
  • Injecting Botulinum toxin type A (Botox) into your anal sphincter. It can temporarily paralyze the anal sphincter muscle, which relieves pain and encourages healing


Surgery for an Anal Fissure

Before considering surgery, your doctor will re-examine you. They conduct other tests to find out why medications have failed to heal your fissure.


Your fissure may not heal because of muscle spasms in the internal anal sphincter muscle or scarring. Surgery usually consists of making a cutting a small portion of the internal anal sphincter muscle. This surgery will reduce pain and allow your fissure to heal. Moreover, cutting the muscle does not result in the loss of controlling your bowel movements.


You can get your surgery done on an outpatient basis, and go home the same day. Your pain will relieve after a few days and completely heal in a few weeks.


Prevention of Anal Fissures

  • Fissures in infants:
  • Changing diapers frequently
  • Treat constipation immediately
  • Fissures in adults:
  • Keep your anorectal area dry
  • Wipe the area using soft materials, a cotton pad, or a moistened cloth. Do not use rough and scented toilet paper.
  • Promptly treat all constipation and diarrhea problems
  • Do not irritate the rectum

 If you find yourself suffering from constant constipation or any other symptoms we mentioned, consult your doctor. The sooner you treat your problem, the better it is for you.

Use over-the-counter stool softeners to treat an anal fissure at home.

To stay hydrated and enhance digestion, drink more water.

Taking fiber supplements and eating more fibrous foods are two ways to improve your fiber intake.

To relax the anal muscles, reduce discomfort, and enhance blood flow to the anorectal area, take a sitz bath.


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