What are anal fissures?
An anal fissure is a crack or tear in the skin of the anal canal (the
opening through which stool passes out of the body) that extends upwards
into the anal canal. Fissures are a common condition of the anus and
anal canal and are responsible for 6-15% of the visits to a colonic and
rectal (colorectal) surgeon. They affect men and women equally and both
the young and the old. Fissures usually cause pain during bowel
movements that often is severe. Anal fissure is the most common cause of
rectal bleeding in infancy.
What causes anal fissures?
Anal fissures are caused by trauma to the anus and anal canal. The cause
of the trauma usually is a bowel movement, and many patients can
remember the exact bowel movement during which their pain began. The
fissure may be caused by a hard stool or repeated episodes of diarrhea.
Occasionally, the insertion of a rectal thermometer, enema tip,
endoscope, or ultrasound probe (for examining the prostate gland) can
result in sufficient trauma to produce a fissure. During childbirth,
trauma to the perineum (the skin between the posterior vagina and the
anus) may cause a tear that extends into the anoderm.
What are the symptoms of anal fissure?
• Sharp, stinging or burning pain during and following a bowel movement.
• Spots of bright red blood on toilet tissue. This blood is separate
from the stool. Blood mixed with the stool indicates some other
conditions (like colon cancer and inflammatory bowel disease). Itching
and malodorous discharge may also occur.
How are anal fissures diagnosed and evaluated?
A careful history usually suggests that an anal fissure is present, and
gentle inspection of the anus can confirm the presence of a fissure. If
gentle eversion (pulling apart) the edges of the anus by separating the
buttocks do not reveal a fissure, a more vigorous examination following
the application of an anesthetic to the anus and anal canal may be