Anal Fissure: Causes, Symptoms, Treatment
General Surgery

Anal Fissure: Causes, Symptoms, Treatment

    An anal fissure is a common medical condition that affects the anal canal, causing pain, discomfort, and potential complications. In this article, we will explore the causes, symptoms, available treatment options, and preventive measures to help you understand and manage anal fissures effectively.

    What causes Anal Fissures?

    An anal fissure is a small tear or crack in the skin of the anal canal. The primary causes of anal fissures include:

    • Constipation: Straining during bowel movements can create pressure on the anal canal, leading to fissures.

    • • Diarrhea: Frequent and loose stools can irritate the anal area, making it more susceptible to fissures.
    • • Anal trauma: Injury to the anal region due to excessive friction or force can cause fissures.

    • Childbirth: Women may develop fissures after giving birth due to the stretching and pressure on the anal area during labor.

    What are the symptoms of Anal Fissures?

    The most common symptoms of anal fissures include:

    • • Intense pain during and after bowel movements.

    • Bright red blood on the toilet paper or in the stool.
    • Itching and irritation around the anus.

    • • Muscle spasms in the anal region (anal sphincter).

    How is Anal Fissure diagnosed?

    Diagnosing an anal fissure usually involves a physical examination of the anal area by a healthcare provider. In some cases, additional tests, such as an anoscopy or sigmoidoscopy, may be recommended to confirm the diagnosis and rule out other conditions.

    What are the treatment options for Anal Fissures?

    Treatment for anal fissures aims to alleviate pain, promote healing, and prevent recurrence. Some common treatment options include:

    • • Topical medications: Over-the-counter or prescription creams or ointments containing hydrocortisone can help reduce inflammation and relieve itching.
    • • Stool softeners and laxatives: These help soften the stool and prevent straining during bowel movements, promoting healing.
    • • Sitz baths: Soaking the anal area in warm water several times a day can provide pain relief and promote hygiene.

    • Botox injections: In some cases, injecting botulinum toxin (Botox) into the anal sphincter can help relax the muscles and promote healing.

    When is surgery required for Anal Fissures?

    Surgery for anal fissures is typically considered when conservative treatments fail to provide relief or when the fissure becomes chronic and does not heal on its own. While most anal fissures respond well to non-surgical treatments, there are certain situations where surgery may be necessary to alleviate symptoms and promote healing.

    • • Chronic Fissures: If an anal fissure persists for more than eight weeks and does not show signs of improvement with conservative treatments, surgery may be recommended. Chronic fissures often have a reduced blood supply to the affected area, hindering the body's natural healing process.
    • • Recurrent Fissures: Some individuals may experience recurrent anal fissures, where the condition keeps coming back despite successful treatments in the past. In such cases, surgery may be considered as a more permanent solution to prevent future fissures.
    • • Severe Pain: Anal fissures can cause excruciating pain, particularly during bowel movements. When the pain is severe and significantly affects a person's quality of life, surgery may be the best option to provide immediate relief and improve the patient's overall well-being.
    • • Persistent Muscle Spasms: The anal sphincter muscle, responsible for controlling bowel movements, can go into spasms in response to the fissure. These spasms can exacerbate the pain and prevent the fissure from healing. Surgery may involve cutting a small portion of the anal sphincter (lateral internal sphincterotomy) to relax the muscle and reduce pressure on the fissure, promoting healing.
    • • Failure of Non-Surgical Treatments: If topical medications, sitz baths, stool softeners, and other non-surgical treatments do not effectively resolve the fissure, surgery may be the next step to address the underlying issue causing the condition.
    • • Complications: In some cases, untreated or severe anal fissures can lead to complications like infection, abscesses, or the development of a chronic fistula (an abnormal tunnel connecting the anal canal to the skin near the anus). Surgery may be necessary to address these complications and prevent further health problems

    In short, surgery is usually considered if conservative treatments do not provide relief or if the fissure becomes chronic. The most common surgical procedure for anal fissures is a lateral internal sphincterotomy, where the surgeon cuts a small portion of the anal sphincter muscle to reduce pressure and allow the fissure to heal.

    What are the surgery options for fissure?

    There are several surgical options for treating anal fissures when conservative treatments have failed to provide relief or when the fissure is chronic and does not heal on its own. The surgical procedures aim to alleviate pain, promote healing, and prevent fissure recurrence. Some common surgical options for anal fissures include:

    Lateral Internal Sphincterotomy (LIS)

    Lateral internal sphincterotomy is one of the most common surgical procedures for anal fissures. During this procedure, the surgeon makes a small incision in the anal sphincter muscle, which is the circular muscle that controls bowel movements. By cutting a portion of the muscle, the pressure on the fissure is reduced, allowing it to heal. The surgery is usually performed under local or general anesthesia.

    Anal Advancement Flap Surgery

    In cases where the anal sphincter muscle cannot be safely cut (as in some complex fissures or recurrent fissures), an anal advancement flap surgery may be considered. During this procedure, the surgeon creates a flap of tissue near the fissure and advances it over the fissure site, covering the wound. This helps to improve blood supply to the area and promote healing.


    A fissurectomy involves the surgical removal of the fissure itself. The procedure is generally reserved for chronic fissures that have failed to heal with other treatments. After removing the fissure, the wound is left open to heal naturally or may be closed with sutures, depending on the surgeon's preference.

    Botulinum Toxin Injection (Botox)

    Botulinum toxin (Botox) injections may be used in some cases to temporarily relax the anal sphincter muscle. By reducing the muscle's tension, Botox injections can promote healing of the fissure. However, the effects of Botox are temporary and may require repeat injections.

    Sphincterotomy with Fissurectomy

    This procedure combines a lateral internal sphincterotomy with the removal of the fissure (fissurectomy). It aims to address both the muscle tension and the fissure itself to enhance healing.

    It's important to note that while surgical treatments can be effective in treating anal fissures, they do carry potential risks and complications, like infection, bleeding, or incontinence. Therefore, surgery is typically considered when other conservative treatments have failed or when the fissure is particularly severe or chronic.

    Before deciding on surgery, patients should have a thorough discussion with their healthcare provider to understand the potential benefits, risks, and expected outcomes of the specific surgical option recommended for their case.

    How to prevent Anal Fissures?

    Preventing anal fissures involves adopting healthy bowel habits and lifestyle changes, such as:

    • Eating a high-fiber diet to prevent constipation.
    • Drinking plenty of water to stay hydrated.
    • Avoiding prolonged straining during bowel movements.
    • Practicing good anal hygiene.

    Anal fissures can cause significant discomfort and pain, but they are treatable with various non-surgical and surgical options. Early diagnosis and appropriate treatment are essential to promote healing and prevent complications. If you experience symptoms of anal fissures or have concerns about your anal health, consult a healthcare professional for proper evaluation and personalized treatment.

    The content of the page is for informational purposes only, please consult your doctor for diagnosis and treatment.