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Anal fissure

Fissure in ano; Anorectal fissure; Anal ulcer

An anal fissure is a small split or tear in the thin moist tissue (mucosa) lining the lower rectum (anus).

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Causes

Anal fissures are very common in infants, but they may occur at any age.

In adults, fissures may be caused by passing large, hard stools, or having diarrhea for a long time. Other factors may include:

The condition affects males and females equally. Anal fissures are also common in women after childbirth and in people with Crohn disease.

Symptoms

An anal fissure can be seen as a crack in the anal skin when the area is stretched slightly. The fissure is almost always in the middle. Anal fissures may cause painful bowel movements and bleeding. There may be blood on the outside of the stool or on the toilet paper (or baby wipes) after a bowel movement.

Symptoms may begin suddenly or develop slowly over time.

Exams and Tests

The health care provider will perform a rectal exam and look at the anal tissue. Other medical tests that may be done include:

Treatment

Most fissures heal on their own and do not need treatment.

To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently.

CHILDREN AND ADULTS

Worrying about pain during a bowel movement may cause a person to avoid them. But not having bowel movements will only cause the stools to become even harder, which can make the anal fissure worse.

Prevent hard stools and constipation by:

Ask your provider about the following ointments or creams to help soothe the affected skin:

A sitz bath is a warm water bath used for healing or cleansing. Sit in the bath 2 to 3 times a day. The water should cover only the hips and buttocks.

If the anal fissures do not go away with home care methods, treatment may involve:

Outlook (Prognosis)

Anal fissures often heal quickly without any more problems.

People who develop fissures once are more likely to have them in the future.

Related Information

Mucosa
Constipation in infants and children
Crohn disease
Chronic

References

Abdelnaby A, Downs JM. Diseases of the anorectum. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 129.

Kliegman RM, Stanton BF, St. Geme JW, Schor NF. Surgical conditions of the anus and rectum. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 344.

Merchea A, Larson DW. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 52.

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Review Date: 6/11/2018  

Reviewed By: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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