Piles / Haemorrhoids
Assessment and treatment of internal and external haemorrhoids, including bleeding, swelling and prolapse.
Learn moreAnal Fissure
Fissure Treatment
An anal fissure is a small tear in the lining of the anal canal that typically causes sharp pain while passing stool. Treatment focuses first on relieving pain and spasm and softening the stool so the tear can heal; where a fissure has become chronic and does not respond, procedural options are discussed after examination.
Overview
A fissure is often described by patients as passing broken glass. The pain comes on with a bowel movement and can continue for minutes to hours afterwards. There may be a small amount of bright red blood on the stool or on the tissue.
The problem tends to become self-sustaining: pain leads to spasm of the internal anal sphincter, spasm reduces blood supply to the tear, and poor blood supply prevents healing. Patients also begin to avoid passing stool, which makes constipation worse.
An acute fissure that is treated early usually heals well. A fissure lasting more than six to eight weeks is considered chronic and may show a thickened edge or a small skin tag, which changes the treatment approach.
Common symptoms
- Sharp, cutting pain while passing stool
- Pain that continues after the bowel movement, sometimes for hours
- Small amount of bright red blood on stool or tissue paper
- Spasm or tightness around the anus
- Fear of passing stool, leading to worsening constipation
- A small skin tag near the anal opening in long-standing cases
Common causes
- Passing hard or bulky stool
- Chronic constipation with repeated straining
- Prolonged or severe diarrhoea
- Reduced blood supply to the posterior anal canal
- Childbirth-related trauma
- Persistent high resting tone of the anal sphincter
How it is assessed
- History focusing on the character and timing of pain
- Gentle local examination; a fissure can often be identified on inspection alone
- Assessment of sphincter spasm and of whether the fissure is acute or chronic
- Examination for associated piles, sentinel tag or fistula
- Further evaluation if the fissure is in an unusual position or is not healing as expected
Treatment approach
- Stool softening and fibre correction so that bowel movements stop re-injuring the tear
- Prescribed local applications and medication to reduce pain and sphincter spasm
- Warm sitz baths, explained properly, to relax the sphincter and improve comfort
- Procedural treatment for chronic fissures that have not healed with medical management
- Review to confirm healing, since a fissure treated only until the pain settles often returns
When you should consult a doctor
- Anal pain during bowel movements lasting more than a week
- Pain severe enough that you are avoiding passing stool
- Bleeding along with pain
- A fissure that heals and then repeatedly returns
- Any discharge of pus, which may suggest an abscess or fistula
FAQ
Questions about anal fissure
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