Anal fissure

Anal Fissure


An anal fissure is a small tear in the thin membrane surrounding the anus known as the mucosa. An anal fissure could form while passing very hard stools. The tear could expose the anal sphincter, a ring of muscle keeping the anus closed, and cause spasms and infection. An anal fissure is considered acute if symptoms last less than 6 weeks, and could be considered chronic if symptoms last longer.

Signs and symptoms

Anal fissures are characterised by extreme pain during bowel movements. The pain may last for several hours after the bowel movement too. In some cases, there is a spot of blood on the stool or the toilet paper after the bowel movement. On inspection, you may find a skin tag or a crack in the skin surrounding the anus.

Causes and risk factors

Infants are quite prone to anal fissures. Anal fissures are commonly caused by constipation, very hard stools, chronic diarrhoea, childbirth or anal intercourse. The fissures could also be caused by anal cancer, HIV, Crohn’s Disease, TB or syphilis.


Anal fissures sometimes extend into the anal sphincter and cause further complications while healing. If the fissure hasn’t healed properly, it will tend to get infected, cause more pain and recur frequently. An anal fissure that hasn’t healed in longer than 8 weeks is considered chronic and may require deeper interventions.


Often, an anal fissure can be diagnosed by a doctor with just a physical exam – A clear tear is usually visible. In case of any underlying conditions or if the doctor deems further investigation necessary, you may be prescribed a Flexible Sigmoidoscopy or a Colonoscopy.

Treatment and Surgical Interventions

Anal fissures can heal on their own within a couple of weeks if efforts are taken to prevent constipation and diarrhoea. Soaking the area in warm water multiple times a day can also help relax the sphincter and promote healing. However, for persistent fissures, the doctor may recommend a course of Botox to relax the sphincter, external nitroglycerine creams, and other topical anaesthetic creams. Chronic anal fissures will require a surgical approach. The surgeon will perform a Lateral Internal Sphincterotomy (LIS), in which a small portion of the sphincter muscle is cut to reduce spasms and promote healing. Surgery is proven to be the most effective treatment for chronic anal fissures.


If you are prone to anal fissures, it is recommended to take measures to prevent constipation as well as diarrhoea. Eat high-fibre foods and stay properly hydrated. Exercise also helps, so the patient strains less during a bowel movement.


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