Anal Fissures

Anal fissures are cuts or tears in the delicate lining of the anus. It is estimated that around 1 in 10 people will have one at some point in their life. Most are shallow, although in more severe cases they can be deep enough to expose the anal sphincter muscle beneath.

These types of fissures can happen at any age for a variety of different reasons. Although sometimes painful, uncomfortable and/or itchy, in most cases, a rectal fissure is not serious and can be successfully treated at home.

However, a chronic anal fissure that’s not healing can sometimes be a cause for concern, so it’s important to get them checked by a doctor.

Anal fissures causes

There are many different possible causes of anal fissures, and you might not always be able to pin down the exact reason yours occurred. Generally speaking, a rectal fissure is the result of damage to the lining of the anal canal or anus, and this can happen in several ways.

Constipation

One of the main causes of anal fissures is constipation. This is because when you’re constipated, your stools often become hard, dry, and larger than normal. Consequently, it’s easy for them to tear the lining of the anus when you have a bowel movement – particularly if you’re straining quite hard.

At the other end of the spectrum, it’s also possible for severe diarrhoea to cause a rectal fissure, for instance, by drying out the skin or because of the acidic nature of the stools.

Tight sphincter muscles

Having unusually tight anal sphincter muscles can lead to increased tension in the anal canal and a greater risk of developing a rectal fissure.

Plus, spasms in the anal sphincter muscles can both cause fissures and exacerbate existing ones.

Anal sex

Engaging in anal sex can result in a person experiencing anal fissures. In fact, inserting any sort of object into the anus could be the cause of anal fissures.

If safe sex is also not carried out and you contract a sexually transmitted infection, you could also go on to experience anal fissures. Certain sexually transmitted infections have been linked to anal fissures.

Other causes of anal fissures

Some additional reasons why you might suffer from anal fissure pain include:

Pregnancy and childbirth
Underlying health conditions such as inflammatory bowel disease
Anal cancer (in rare cases)

Anal fissures symptoms

There are a number of symptoms that can be caused by anal fissures. You may experience some, all, or none of these – and to different degrees – depending on the severity of your rectal fissure. The most common are:

Sharp pain when defecating
Anal fissure pain when wiping your bottom
Bleeding when defecating (usually bright red blood, which you can see either on the toilet paper or in your stool)
A deep, burning pain after bowel movements (this can last several hours)
A visible crack in the skin in and/or around the anus
A small lump next to the rectal fissure
The area around the anal fissure itching

The pain from anal fissures can be particularly bad if the tear is deep and exposes the sphincter muscle or if the muscle spasms.

Anal fissures treatment

In most instances, the symptoms of a rectal tear will go away without the need for medical intervention. However, anal fissure treatment can be a helpful way to relieve pain and speed up the healing process.

In rare cases where a tear is chronic, recurring, or resistant to home remedies, anal fissure surgery might be recommended.

How to diagnos anal fissures

If you notice symptoms of anal fissures, such as those outlined above, it’s sensible to book an appointment with your doctor. There are several conditions that may present with similar symptoms, so this will enable you to find out whether you have a haemorrhoid, fissure, or something else.

Your GP will first want to talk to you about the specific symptoms you’re experiencing – such as the type of pain and amount of blood – and how long you’ve had them. They may also ask about your current toilet habits, for example, whether you’re also suffering from constipation.

In most cases, the doctor will then want to do a visual examination in order to make a diagnosis. Anal fissures can normally be seen by gently parting the buttocks.

A relatively recent rectal fissure looks a little bit like a paper cut, whereas a more chronic one might be deeper and have a lump or skin tag alongside it.

The GP may also wish to perform an internal examination depending on what they find. This could be either using a gloved finger to check for abnormalities inside the anus or a more thorough check with a small camera or an instrument with a light.

However, in the majority of circumstances, this won’t be necessary.

Once they have a definite diagnosis and assessment of the severity of your condition, the doctor will be able to suggest the best cream for piles and fissures along with some home remedies you can try. This is normally enough for a full recovery.

How do you treat and heal anal fissures?

For most people, the recommendation will be anal fissure treatment at home. This might include remedies such as the following:

Soak the affected area in a warm bath to promote healing and provide anal fissure pain relief.
Use moist wipes rather than dry toilet paper when wiping your bottom to avoid irritating the rectal fissure.
Wipe your anal region with a patting motion rather than rubbing it. This is a delicate part of the body, so treat it gently.

Your doctor may prescribe laxatives in order to help soften your stools and allow you to defecate more easily.

They might also suggest painkillers, suppositories that you insert inside the rectum or a topical anal fissure cream that you can put directly on the affected area. Both suppositories and topical cream can provide effective pain relief as you heal. Most people find that their anal fissures clear up within a few weeks this way.

Constipation treatment

Constipation is one of the main causes of anal fissures. If you suspect it to be behind yours, then try treating it directly with the following tips:

Increasing the amount of fibre in your diet
Drinking lots of water
Not ignoring the need to defecate, even if you’re concerned about resulting anal fissure pain
Keeping active to promote bowel movement
Not straining too hard
Not using perfumed products (such as soap or shower gel) that might irritate the area – treat anal fissures like any other open wound

Surgery

If your anal fissure’s not healing or your symptoms are very severe, the GP might recommend that you have surgery.

This is generally an effective method but can carry a small risk of temporary or permanent bowel incontinence. As such, it’s not an option you want to rush into before trying those at-home remedies listed above.

The types of surgery available for rectal tears include:

Lateral sphincterotomy – This involves making a small cut in the ring of muscle to help reduce tension in the anal canal and allow anal fissures to heal.
Advancement anal flaps – This is where healthy tissue from another part of your body is used to repair the fissure and improve the blood supply to the area.

There is also a fairly new non-surgical technique available, where botox is used to paralyse the sphincter muscle. This prevents it from spasming, provides anal fissure pain relief, and enables the rectal fissure to heal.

Prevent anal fissures

There are several diet and lifestyle changes you can make to help reduce your risk of developing anal fissures in the first place or preventing them from returning. Many of these relate to preventing constipation. For example:

Eat a healthy and balanced diet that’s rich in high fibre foods such as brown rice, wholewheat pasta, granary bread, lentils, pulses, fruit, vegetables, and nuts. Avoid foods such as dairy products, meat, and white bread.
Stay hydrated by having six to eight glasses of water a day. Avoid caffeinated drinks and alcohol.
Don’t spend too long on the toilet, strain too hard during bowel movements, or ignore the need to defecate.
Keep your anal region clean and dry.
Exercise regularly in order to keep your digestive system moving and working well.

Anal fissures FAQs

What is the main cause of fissure?

Out of all of the causes, constipation is considered to be one of the main causes of anal fissures.

How do I know if I have a haemorrhoid or fissure?

As these two conditions often present with similar symptoms, it can be hard to tell whether you have haemorrhoids (piles) or an anal fissure. The best way to know is to go to your GP for an official diagnosis. Having said that, there are differences between the two which you might be able to spot yourself, for example:

Anal fissures look like cuts or cracks in the skin, whereas haemorrhoids have the appearance of swollen lumps.
You may find a slimy mucus on the toilet paper after bowel movements with haemorrhoids.
You can sometimes feel a haemorrhoid pop out of your anus and are then able to push it back in.

How long do anal fissures last?

For most people, a rectal fissure takes a few weeks to heal. You can speed the recovery time up by following the above-mentioned anal fissure treatment at home. If they last for more than six weeks, they are considered to be chronic fissures. This is when medical intervention – either surgical or non-surgical – should be considered. Be sure to go to the doctor at this point if you haven’t already.

What happens if an anal fissure goes untreated?

If your symptoms are not severe, you will likely find that you heal perfectly well without any anal fissure treatment. However, you will generally recover more quickly if you follow the advice above, plus get an anal fissure cream or other medication from your doctor.

If you suffer from a chronic anal fissure or very painful symptoms, you may find you are unable to fully recover without some medical intervention. In this case, leaving it untreated is not advised because such anal fissures can have a strong negative impact on your quality of life.

Do I need to go to the doctor for anal fissure treatment?

People are often embarrassed to go to the GP about an anal fissure. However, in most cases, it’s the best course of action, even when following the at-home remedy recommendations above.

Seeking treatment allows the doctor to confirm that you’re definitely suffering from anal fissures and that your symptoms are not a sign of a more serious health condition.

This is in addition to prescribing an anal fissure cream or anal fissure suppositories and any other medication necessary, allowing you to achieve a full recovery in the quickest possible time.