Anal Fissure: Symptoms, Causes, Treatment & Prevention

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An anal fissure is a common medical condition that affects the anus and can cause significant discomfort and pain. It is characterized by a tear or ulceration in the lining of the anal canal, which can cause pain, bleeding, and itching. Anal fissures can be acute or chronic and are often associated with conditions such as constipation, diarrhoea, or inflammatory bowel disease [1] [2]. In this article, we will discuss the symptoms, causes, treatment, and prevention of anal fissures with reference to scientific studies.

Symptoms of Anal Fissure

Symptoms of anal fissures can vary depending on the severity of the condition, but the most common symptoms include [1] [2]

  • Pain During Bowel Movements

Anal fissures can cause sharp, severe pain during bowel movements that may last for several hours. The pain is usually described as burning, tearing, or stinging, and it can be so intense that it causes the person to avoid going to the bathroom.

  • Bleeding

A small amount of bright red blood may be seen on the toilet paper or in the toilet bowl after a bowel movement. This occurs because the anus has torn and the blood vessels in the area have been damaged.

  • Itching or Irritation

The skin around the anus may become irritated and itchy as a result of the fissure.

  • Muscle Spasms

Some people may experience involuntary muscle spasms in the anal area, which can worsen pain and discomfort.

  • Swelling

In some cases, anal fissures can cause swelling around the anus, which can make bowel movements even more painful.

  • Recurring Pain and Discomfort

If left untreated, anal fissures can become chronic, leading to recurring pain, discomfort, and difficulty with bowel movements.

It is important to note that these symptoms can also be indicative of other conditions such as haemorrhoids or inflammatory bowel disease, so it is important to seek medical attention for proper diagnosis and treatment.

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Causes of Anal Fissure

Anal fissures can be caused by a variety of factors, including constipation, diarrhoea, trauma to the anal area, and inflammatory bowel disease. Chronic diarrhoea can irritate the anal area, while constipation can cause hard stools that stretch the anal canal and lead to tearing. Trauma to the anal area can occur during childbirth or from anal sex. Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, can also increase the risk of anal fissures [1] [2]

Treatment for Anal Fissure

Treatment options for anal fissures include both non-surgical and surgical interventions. Non-surgical treatment options include [3]

  • Topical Medications

Over-the-counter creams and ointments such as hydrocortisone and lidocaine can help to reduce pain and inflammation in the affected area. Prescription-strength medications may also be prescribed by a healthcare provider.

  • Stool Softeners

Hard stools can exacerbate anal fissures and make them more painful. Taking stool softeners such as docusate sodium can help to make bowel movements less painful and reduce the risk of further injury.

  • Dietary Changes

Increasing fibre intake and drinking plenty of water can help to soften stools and reduce constipation, which can, in turn, reduce the risk of anal fissures. It is also important to avoid spicy and acidic foods, which can irritate the anal area.

  • Sitz Baths

Soaking in warm water for 10-15 minutes several times per day can help to soothe the anal area and promote healing. Adding Epsom salts or other soothing agents to the water can also be beneficial.

If non-surgical interventions are not effective, surgery may be necessary. The two main surgical options for anal fissures are:

  • Lateral Internal Sphincterotomy 

This procedure involves cutting the muscle that controls the anus, which can reduce pressure on the fissure and promote healing. It is typically done under general anaesthesia and requires a short hospital stay [4].

  • Anal Fistulectomy 

This procedure involves surgically removing the fissure and any scar tissue that may have formed. It is typically done under general anaesthesia and requires a longer recovery period than a lateral internal sphincterotomy [5].

It is important to note that the choice of treatment will depend on the severity of the fissure, as well as the individual’s overall health and medical history. A healthcare provider can help to determine the most appropriate treatment plan.

Preventing Anal Fissure

Preventing anal fissures involves maintaining healthy bowel habits and avoiding trauma to the anal area. This includes eating a high-fibre diet, drinking plenty of water, and exercising regularly to prevent constipation. Avoiding straining during bowel movements can also reduce the risk of anal fissures. Using a stool softener or fibre supplement can also help to prevent constipation. Avoiding trauma to the anal area, such as from anal sex or childbirth, is also important in preventing anal fissures [1] [6].


In conclusion, anal fissures are a common medical condition that can cause significant discomfort and pain. They are often associated with conditions such as constipation, diarrhoea, or inflammatory bowel disease. Treatment options include over-the-counter creams and ointments, prescription medications, and surgery. Prevention involves maintaining healthy bowel habits and avoiding trauma to the anal area. With proper treatment and prevention, most cases of anal fissures can be successfully managed. 

Disclaimer: The information provided in this article is for education and general awareness. It is not intended to substitute any medical advice. Please consult your healthcare professional for any medical information.