Anal fissure

An anal fissure is a small tear of your skin just inside the opening of your anus.

They are very common in people of all ages, but are most common in teenagers and young adults.

They can be very painful, especially when opening your bowels (passing faeces). They can be very upsetting but are very rarely serious.

The fissure may bleed a little and stain the toilet paper with bright red blood after opening your bowels.

An anal fissure will usually heal on its' own, but this often takes several weeks. The fissure may not heal and may become chronic. This is because the blood supply may be reduced to the skin of your anus due to the muscles tightening in response to the pain, so preventing healing.

It is thought that anal fissures are commonly caused by constipation due to passing a large or hard stool, causing stretching and tearing. Tightening of the muscles around the anus may help cause the tear and may slow down the healing process.

They can also occur after a period of diarrhoea or for no obvious reason. In women about 1 in 10 cases occur during childbirth.

Rarely, anal fissures can be associated with more serious inflammatory bowel conditions. If this is the case, there will be other symptoms and problems as well.

The main symptom is sudden pains in or around your anus. This occurs during or shortly after opening your bowels. These pains are typically sharp and knife-like due to the fissure opening up each time your bowels are opened. The muscles may also tighten and go into spasm making the pain worse and prevent healing.

Sometimes a swollen skin tag, called a sentinel pile, forms on the outside of the anus at the lower end of the fissure. A sentinel pile is not a haemorrhoid.

Most anal fissures are at the back of the anal opening (99% of men: 90% of women) Occasionally (10% women) are at the front, especially just after child- birth. If you have multiple fissures or they are at an unusual site it may be due to a more serious cause e.g. Crohn's Disease, Syphilis, an anal herpes infection.

You should see your doctor if you have symptoms of an anal fissure, (such sharp knife-like pains and red bleeding on to the toilet paper after opening your bowels) for a week or so. The doctor will ask you about your bowel habits and examine the anal area.

In most cases the fissure will heal within a couple of weeks, and the only treatment that may be necessary is help with the pain and to keep the faeces soft whilst the fissure heals.

You should take warm baths and take painkillers (paracetamol) if necessary, but avoid painkillers containing codeine as these often cause constipation. You should eat lots of fibre by eating fruit, vegetables, cereals, brown rice, wholemeal bread, etc. If necessary, you can also take bran, or other fibre supplements (bulk-forming laxative), which you can buy from your pharmacist.

You should drink plenty of water and avoid too much tea and coffee as these can make constipation worse.

You can get an ointment that contains a local anaesthetic on prescription from your doctor or over the counter from your pharmacist to reduce pain and inflammation. You should only use this for a few days at a time, as it can irritate the skin around your anus.

You can also get an ointment that contains a steroid on prescription from your doctor. This will reduce swelling and inflammation around your anus. You should not use this for longer than a week at a time.

Glyceryl trinitrate (GTN) can be used for the treatment of chronic anal fissures. This ointment should be applied to the skin around your anus three times a day. It helps to relax your anal muscle, reduce pain, relieve the spasm of the muscles and improve the blood supply to the fissure. The most common side effect is headache.

Some people require a minor surgical operation to cure a chronic anal fissure. The most commonly used operations to treat anal fissures are an internal sphincterotomy (cutting the internal anal muscle) or anal dilatation (stretching the internal anal muscle). These procedures are carried out in hospital under general anaesthetic. Surgery is very effective, but carries a small risk of some degree of incontinence (of faeces or wind), although this may improve with time.

If your bowel habits have recently changed or you have been losing weight and have blood in your faeces, you should seek medical advice, as these symptoms could be due to a more serious condition.

No info

Keeping the stools soft with a high-fibre diet and drinking plenty of water is the main way to prevent fissures.

Avoid constipation. Always go to the toilet when you feel the urge. Wash the anal area after each defecation. Bidets are useful. NHSDEC07