Causes and Prevention of Anal Fissures

An anal fissure is caused by a small tear in the thin, moist tissue that lines the anus. It can form when you pass hard or large stools during a bowel movement. If you have an anal fissure, you may experience pain and bleeding. Spasms in the anal sphincter (the ring of muscle at the end of your anus) are also common.

Board-certified colon and rectal surgeon Lisa Perryman, MD helps patients with a full spectrum of colorectal conditions at Colorado Colon & Rectal Specialists in Parker, Colorado. Anal fissures are rarely a sign of something serious, but they can cause significant discomfort and disrupt your daily life. If you’re struggling with bothersome symptoms, Dr. Perryman can evaluate your symptoms and devise a treatment plan.

Anal fissure overview

Anal fissures can occur at any age and are common in infants. Simple treatments, such as increased fiber intake or sitz baths, can help most anal fissures heal. Anal fissures may require medication or, in rare cases, surgery. 

Signs of anal fissure

Common signs of an anal fissure include:

• Pain after a bowel movement
• Constipation
• Bleeding
• Itching
• Burning

It’s also common to experience anal pain in the evening hours. 

Common causes of anal fissure

Trauma to the anus and anal canal can cause anal fissures. One or more of the following factors may contribute:

• Long-term constipation
• Straining during bowel movements
• Tight anal sphincter
• Anorectal scarring 
• Inflammatory bowel disease
• Reduced blood flow to the anorectal area

Women are at a higher risk of developing an anal fissure after childbirth. 

Preventing anal fissures

By avoiding constipation or diarrhea, you may be able to avoid developing an anal fissure. To avoid having to strain during bowel movements, eat high-fiber foods, drink plenty of water, and exercise regularly. If you have chronic constipation, it’s important to discuss it with Dr. Perryman, since constipation increases the chances of issues such as hemorrhoids and anal fissures. 

Anal fissure treatment

The goal of anal fissure treatment is to relieve discomfort and bleeding by softening stools and lowering pressure on the anal canal. Conservative measures are the first step. 

Using stool softeners, drinking more fluids while avoiding caffeine-containing products and making dietary changes to avoid constipation are good first steps. To help relax the anal muscles, try soaking in a warm bath (also known as a sitz bath) for 10 to 20 minutes several times a day.

It’s important to avoid straining during bowel movements. Most fissures heal within a few weeks to months using these techniques. When conservative treatments fail and anal fissures persist or return, other options can be considered.

To reduce inflammation, using hydrocortisone-containing suppositories, foams, or creams can help reduce inflammation.

Botulinum toxin type A (BotoxⓇ) can be injected into the anal sphincter to temporarily relax it, relieve pain and promote healing. 

Anal fissure surgery

Before recommending surgery, Dr. Perryman may order additional tests to figure out why other treatments have failed to heal the fissure.

Scarring or muscle spasms of the internal anal sphincter muscle can cause a fissure to fail to heal. To relieve pain and spasms and promote healing, surgery usually involves cutting a small portion of the internal anal sphincter muscle. 

Anal fissure surgery is an outpatient procedure. You can expect to go home the same day. Discomfort subsides a few days after surgery, and healing takes a few weeks.

If you’re dealing with an anal fissure it’s wise to see a rectal pain specialist. Get in touch with our office by phone or book online to schedule a visit with Dr. Perryman.