• Anal fissures are cracks or tears in the anus and anal canal. They may be acute or chronic.
• Anal fissures are caused primarily by trauma, but several non-traumatic diseases are associated with anal fissures and should be suspected if fissures occur in unusual locations.
• The primary symptom of anal fissures is pain during and following bowel movements. Bleeding, itching, and a malodorous discharge also may occur.
• Anal fissures are diagnosed and evaluated by visual inspection of the anus and anal canal. Endoscopy and, less commonly, gastrointestinal X-rays may be necessary.
• Anal fissures are initially treated conservatively by adding bulk to the stool, softening the stool, consuming a high fiber diet, avoiding “sharp” or poorly digested foods, and utilizing sitz baths.
• Ointments containing anesthetics, steroids, nitroglycerin, and calcium channel blocking drugs (CCBs) are used for treating anal fissures that fail to heal with less conservative management.
• Injections of botulinum toxin may be effective when ointments are not effective. (The cost of treatment would be substantially reduced if the toxin were packaged in smaller doses.)
• Surgery by lateral sphincterotomy is the gold standard for curing anal fissures. Because of complications, however, it is reserved for patients who are intolerant of non-surgical treatments or in whom non-surgical treatments have proven to be ineffective.
For unknown reasons, anal fissures are common during infancy. They occur in approximately 80 percent of babies during the first year of life. Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. During and after childbirth, women are at risk because of the straining during delivery.
If you have an inflammatory bowel disease, such as Crohn’s disease, you have a higher risk of developing anal fissures. This is because the inflammation in the intestinal lining makes the tissue more prone to tearing. You are at risk of developing anal fissures if you experience frequent constipation where you have to strain to pass stools.
Although anal fissures cannot always be prevented, you can reduce your risk of getting one with the following guidelines:
To prevent anal fissures in infants, change diapers frequently
• Keep the anal area dry
• Cleanse the anal area gently
• Avoid constipation by drinking plenty of fluids, eating plenty of fiber, and exercising regularly
• Treat diarrhea immediately