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Anal fissure

Published by Bupa's health information team, September 2008.

This factsheet is for people who have an anal fissure, or who would like information about it.

An anal fissure is a small tear in the skin around the opening of your anus. It can cause sharp pain, especially when opening your bowels. Anal fissure is a common disorder but many people don't seek medical advice about it.

About anal fissure

Anal fissure is a common condition that can affect you at any age. An anal fissure can be confused with piles (haemorrhoids) because the symptoms are similar.

Most anal fissures are at the rear of the anus - in line with the cleft of the buttocks. A fissure can also occasionally occur at the front of the anus, especially just after childbirth.

Illustration showing the anus with an anal fissure
The anus with an anal fissure

Symptoms of anal fissure

If you have an anal fissure, you may have the following symptoms.

Acute and chronic anal fissures

There are two types of anal fissure - acute and chronic. An acute illness is typically over quite quickly, a chronic illness is one which lasts a long time. The terms acute and chronic refer to time, not how serious a condition is.

Causes of anal fissure

Often no cause is found for an anal fissure. Acute anal fissures can form if you are constipated or after a bout of diarrhoea. They can also occur during pregnancy. About a quarter of people with chronic anal fissures suffer from constipation - straining during a bowel movement can tear the skin of the anus. Anal fissures in children are mainly caused by constipation. If you think your child has an anal fissure, see your GP for advice.

The internal and external sphincters are muscles that control the opening and closing of the anus by relaxing and tensing. Both muscles need to relax for you to have a bowel movement. You can tense or relax your external anal sphincter, but not your internal anal sphincter. Because of the pain of a fissure, your internal anal sphincter may go into spasm (the muscle contracts of its own accord). This causes increased pressure within your anus, making it even harder to have a bowel movement and making your constipation worse.

If your anal fissure is large or irregular, or if you have many anal fissures, this could be a sign of a condition such as Crohn's disease, ulcerative colitis or a sexually transmitted infection.

Diagnosis of anal fissure

If your symptoms don't improve within a couple of weeks, you should visit your GP for advice and to rule out other conditions (see Causes of anal fissure). Don't be embarrassed to see your GP about anal problems - if picked up early, most problems can be treated.

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

Treatment for anal fissure

Self-help

Changes to your diet will help your anal fissure to heal. The main aims are to prevent constipation and make your faeces (stools) smaller and softer.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

It may help to use a lubricant such as petroleum jelly around your anus before you have a bowel movement. Sitting in a warm bath after a bowel movement may relieve your discomfort.

If your anal fissure doesn't heal despite these home treatments, or if you are worried about it, you should see your GP.

You should also see your GP if you have:

These symptoms may be caused by problems other than an anal fissure. You should visit your GP for advice.

Medicines

Acute anal fissure

If necessary you can take over-the-counter painkillers such as paracetamol, ibuprofen or aspirin.

Your GP may prescribe you a cream, ointment or suppository that contains a local anaesthetic, such as lidocaine, and/or steroids, such as hydrocortisone (eg Perinal).

These medicines will help to relieve the spasm of an anal fissure. Your GP may also prescribe laxatives and will give you advice about preventing constipation.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Chronic anal fissure

Medicines for chronic anal fissure aim to reduce spasms and reduce the pressure in the anus.

As well as the medicines and self-help for acute anal fissure your GP may also prescribe glyceryl trinitrate (eg Rectogesic). This is a rectal ointment that relaxes the internal anal sphincter muscle. This reduces the spasm and improves the blood flow to the anus, helping the fissure heal. Using the ointment may mean that you won't need more invasive treatment such as surgery.

A number of other medicines for anal fissure are sometimes used, such as botulinum A toxin (eg Botox) or calcium channel blockers (eg topical Nifedipine). These medicines act by relaxing part of the sphincter to reduce the spasm and the pressure in the anus. Studies of these treatments have produced mixed results so you should ask your GP for advice. Botulinum A toxin and calcium channel blockers aren't currently licensed in the UK to treat anal fissures but they can be prescribed by doctors for "off-label" use. This means the medicine is being used to treat a condition that it wasn't licensed for and isn't described in its patient information leaflet. Your GP can legally prescribe outside the licence or off-label, if he or she feels the medicine will be effective for you.

Ask your GP for more information about medicines for anal fissure.

Surgery

Most anal fissures heal with the use of medicines or by changing your diet. You may need surgery if you have a chronic anal fissure that doesn't get better.

The aim of surgery is similar to that of medicines - to relieve the pressure within the anus. The most common operation is called a lateral internal sphincterotomy (LIS). You can have this as a day case under local or general anaesthetic. Local anaesthetic completely blocks feeling from the anal area and you will stay awake during the operation. General anaesthetic means you will be asleep during the operation and feel no pain.

In a LIS procedure your surgeon will make a small cut to access the internal sphincter. He or she will then make a small cut in the internal sphincter to relieve the spasm associated with anal fissures.

LIS is a very effective treatment with a success rate of about 95 percent, but there's a small risk you might have some incontinence - mainly to wind. It's also possible that your anal fissure may re-occur after surgery.

Prevention

The best way to prevent an anal fissure is to try not to get constipated by eating enough fibre and drinking enough water (see Self-help).

Further information

Related topics

Sources

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2008