• Anal Fissure


    An anal fissure is a cut or tear in the lining of the anus. The anus is the opening through which stool leaves the body. Tears generally occur just inside the opening.
    Anal Fissure
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.


    The exact cause of an anal fissure is unknown. In most cases, tearing is the result of trauma to the anal lining. Trauma can be caused by:
    • A large, dry, or hard stool
    • Frequent diarrhea
    • Tightened anal sphincter, a group of muscles that open and close the anus
    • Childbirth
    • Anal irritation

    Risk Factors

    Factors that may increase your chance an anal fissure include:


    Anal fissure may cause:
    • Pain during and after a bowel movement
    • Burning sensation during a bowel movement
    • Bleeding with bowel movements that result in bright red blood either on the toilet tissue or in the bowl
    • Small amounts of mucous may be present
    Apprehension about bowel movement pain may cause you to delay bowel movements. This can make the symptom worse.


    The doctor will ask about your symptoms and medical history. A physical exam will be done. Anal fissures are generally visible, so diagnosis can be made with an anal exam. If it is not visible, but suspected, your doctor may need to do other tests as long as it is not too painful. These tests include:
    • Digital rectal exam—to feel for any lumps or abnormalities
    • Anoscopy—examination of the anal canal with a scope
    Fissures usually occur in predictable locations around the anus. If there are multiple cuts, or a cut in an unusual location, the doctor may order additional tests to look for other conditions.


    Treatment aims to heal the cut and prevent future anal problems. Most fissures heal on their own or with self-care. Fissures that are fairly new are easier to heal than ones that have persisted for longer than 3 months.
    Treatments include:


    Fissures may heal by changing some of your daily habits. These include:
    • Warm sitz baths, especially after bowel movements, to help relieve pain and promote healing
    • Increasing dietary fiber intake
    • Increasing fluid intake
    • Using stool softeners or bulk laxatives


    Your doctor may prescribe:
    • Topical medications to reduce pain and inflammation
    • Topical nitrates and calcium channel blockers to increase blood flow to the anus and promote healing
    • Injected botulinum toxin to relax tightened anal sphincter muscles


    Surgery may be necessary for:
    • Fissures that do not heal with other treatment methods
    • Scar tissue or spasms in the anal sphincter muscles that may also delay healing
    • Recurrent fissures
    Surgical procedures include:
    • Lateral internal sphincterotomy—A tiny incision is made in the sphincter muscle fibers to prevent spasms that result in straining during a bowel movement.
    • Fissurectomy—Excision of the fissure
    • Anal advancement flap—Covering the fissure with tissue from another part of the body
    • Anal dilation—Rare procedure that widens and stretches the anal canal


    To help reduce the chance of an anal fissure:
    • Drink plenty of fluids throughout the day
    • Exercise regularly
    • Eat foods high in fiber, such as fruits, vegetables, legumes, and whole grains
    • Avoid straining during bowel movements
    • Follow your treatment plan if you have Crohn's disease or ulcerative colitis


    American College of Gastroenterology http://gi.org

    American Society of Colon and Rectal Surgeons http://www.fascrs.org


    Canadian Association of Gastroenterology http://www.cag-acg.org

    Capital Health http://www.cdha.nshealth.ca


    Anal fissure. American Society of Colon & Rectal Surgeons website. Available at: http://www.fascrs.org/patients/disease-condition/anal-fissure. Updated October 2012. Accessed November 9, 2015.

    Anal fissure. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated July 9, 2015. Accessed November 9, 2015.

    Fargo M, Latimer K. Evaluation and management of common anorectal conditions. Am Fam Physician. 2012;85(6):624-630.

    Revision Information

  • LiveWell personal health survey

    How healthy are you really? Find out – free.Learn more

    It's time to stop guessing. If you want to make some changes but just aren't sure how, the free personal health survey from LiveWell is a great place to start.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease and prevent heart attacks. HeartSHAPE® is a painless, non-invasive test that checks pictures of your heart for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.

  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.