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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).

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:

  • Decreased blood flow to the area
  • Too much tension in the sphincter muscles that control the anus

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:

  • Anoscopy -- examination of the anus, anal canal, and lower rectum
  • Sigmoidoscopy -- examination of the lower part of large intestine
  • Biopsy -- removal of rectal tissue for examination
  • Colonoscopy -- examination of the colon

 

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:

  • Making dietary changes -- eating more fiber or bulk, such as fruits, vegetables, and grains
  • Drinking more fluids
  • Using stool softeners

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

  • Numbing cream, if pain interferes with normal bowel movements
  • Petroleum jelly
  • Zinc oxide, 1% hydrocortisone cream, Preparation H, and other products

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:

  • Botox injections into the muscle in the anus (anal sphincter)
  • Minor surgery to relax the anal muscle
  • Prescription creams such as nitrates or calcium channel blockers, applied over the fissure to help relax the muscles

 

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.

 

 

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.

Text only

 
  • Rectum

    Rectum - illustration

    The rectum is the final portion of the large intestine. It empties stool from the body through the anus.

    Rectum

    illustration

  • Normal anatomy

    Normal anatomy

    Presentation

    • Rectum

      Rectum - illustration

      The rectum is the final portion of the large intestine. It empties stool from the body through the anus.

      Rectum

      illustration

    • Normal anatomy

      Presentation

    Self Care

     

      Tests for Anal fissure

       
         

        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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