Anal Fissures

An anal fissure is no more than a tear or cut of the anal skin below the dentate line in the anal canal, usually very small. This injury can cause severe and disabling pain to the patient.

Anal fissures are mainly caused by trauma to the anal canal, such as, with the passage of hard stool. Other theories include reduced blood flow, known as ischemia, to the posterior midline of the anus. 

Fissures are usually located in the posterior midline of the anus, but can also be seen in the anterior midline, and in both locations at the same time. When a fissure is located off the midline of the anus, the clinician should investigate other potentially complicated disease processes, such as Crohn’s disease, trauma, tuberculosis, syphilis, HIV/AIDS, or anal carcinoma. 

Symptoms of an anal fissure include:

• Rectal bleeding
• Pain
• Burning after defecation that could last from minutes to hours

Most anal fissures heal by themselves, but your doctor may prescribe the following to relieve discomfort and promote healing:

• Fiber supplements
• Stool softeners
• Laxatives
• Topical pain relievers
• Anti-inflammatory medication

Fissures that persist longer than six weeks are considered chronic and may require surgery. Consult with your physician if your symptoms continue or worsen.