Anal Fissures | Digestive Health Program | Loyola Medicine

Anal Fissures

Overview and Facts about Anal Fissures

Anal fissures are injuries to the anus in the form of cracks or tears in skin tissue. Your anus is located at the very end of your digestive tract, after your rectum. Anal fissures commonly occur in men, women, and children of all ages.

Anal fissures occur when the thin and moist skin located inside and outside of the anus, called the anal mucosa, is overstretched and/or irritated enough to cause uncomfortable symptoms.

Signs and Symptoms of Anal Fissures

Although the symptoms and causes of anal fissures are similar to that of hemorrhoids, or inflamed blood vessels inside or outside of the anus, anal fissures are distinct from hemorrhoids in that they involve tears or cracks to the anal mucosa (hemorrhoids do not). Acute or short-term anal fissures last for 8 to 12 weeks, while chronic or long-term anal fissures typically last beyond 12 weeks.

Symptoms of anal fissures include:

  • Avoiding the bathroom to avoid pain from bowel movements
  • Bleeding or blood clotting in or around the anus
  • Difficulty making bowel movements
  • Pain and discomfort (such as itching and burning) around the anus
  • Uncontrolled gas and bowel movements

Causes and Risk Factors of Anal Fissures

Anal fissures may occur if a constipated person passes a large stool through the anus, which can cause injury to the anal mucosa.  

Although there are many causes of anal fissures, they are often seen in women just after childbirth, as childbirth can cause direct damage to the anal canal.

Other causes and risk factors include:

  • A diet low in fiber, which can lead to constipation or the formation of hard stools
  • Decreased blood flow to the anus
  • Dehydration, which can also lead to constipation or the formation of hard stools
  • Diarrhea, which can irritate the anal mucosa
  • Eating or over-indulging in spicy foods, which can form stools that irritate the anal mucosa
  • Tension in sphincter muscles that control the opening and closing of the anus

Test and Diagnosis of Anal Fissures

A physical exam of the anus or rectum is often performed to identify irritation or signs of inflammation, in or around the anus. To get a closer look at the potential causes, a doctor may also perform an anoscopy, which is an imaging technique used to examine the anus, anal canal, and lower rectum. A colonoscopy may be performed to examine the colon, which is located just above the rectum. A small tissue sample of the anus or rectum may also be removed for examination under a microscope.

Treatment and Care for Anal Fissures

Anal fissures often go away on their own once lifestyle changes are made, such as an improved diet that is high in fiber and improved hydration. In some cases, laxatives or stool softeners are recommended. Warm baths without chemicals, soaps, salts, or shampoos may also relieve symptoms.

Other types of treatments include applying petroleum jelly, hydrocortisone cream, or numbing cream, to relieve symptoms. Doctors may also prescribe creams with nitrates or calcium blockers to treat the affected area.