What is an anal fissure?

An anal fissure is a small cut in the skin of the anus. The anus is the opening through which bowel movements pass. Anal fissures are a fairly common disorder and occur more often in women.

How does it occur?

Anal fissures are usually caused by small tears in the skin of the anus. These tears occur during bowel movements when hard, dry stools are passed. They may also be associated with:

• straining at bowel movements when you are constipated

• hemorrhoids

• stress

• waiting too long to have a bowel movement (BM)

• anal surgery

• inflammation of the rectum.

What are the symptoms?

Symptoms can include:

• painful bowel movements

• spasm in the muscle at the opening of the anus, caused by irritation of the cut during a bowel movement

• bright red blood when you have a bowel movement, which you see on the BM, in the water, or on the toilet tissue.

How is it diagnosed?

Although the doctor can usually diagnose an anal fissure by physical exam, a procedure called anoscopy may be used to confirm the diagnosis. This procedure uses an instrument called an anoscope to examine the anus and lower part of the rectum.

Your doctor may want to perform additional studies, such as a sigmoidoscopy, if there is any question about the cause of the fissure.

How is it treated?

Treatment for anal fissures includes both medical treatment and home care. Stool softeners and temporary use of pain-relieving cream or ointment may be used.

For fissures that recur or don't heal, an internal anal sphincterotomy may be necessary. This procedure stops the painful spasms that occur, allows for much easier bowel movements, and allows the tear in the anal skin to heal.

How long will the effects last?

An anal fissure usually heals by itself in a few days, although muscle spasms may delay healing.

How can I take care of myself?

Follow these guidelines to treat anal fissures at home:

• Eliminate the hard, dry stools that cause tearing of the anus by:
  • following the doctor's instructions for taking stool-softening medications

  • drinking plenty of water (up to eight 8-ounce glasses a day)

  • adding more fiber to your diet with psyllium (a naturally mild laxative), whole-grain foods, and raw fruits and vegetables.
• Soak in a warm bath to relieve painful spasms.

Do not use analgesic creams or ointments for more than a few days without a doctor's instructions. Many of these products cause allergic skin reactions and worsen the condition.

What can be done to help prevent anal fissures?

The best prevention for anal fissures is to keep stools soft and maintain a healthy lower intestinal tract. This includes:

• drinking plenty of water (up to eight 8-ounce glasses a day)

• eating foods high in fiber

• exercising regularly every day.