Fissure in Ano

What is an Anal Fissure?

An anal fissure is a tear in the lining of the lower rectum (anus) that causes pain during bowel movements. It is a common condition. If you have an anal fissure that has not healed after 6 weeks, it is considered a long-term problem (chronic). Surgery may be necessary for fissures that do not heal with medicine. Anal fissures affect people of all ages, particularly young and otherwise healthy people. They are equally common in men and women. Sometimes an anal fissure and a hemorrhoid/pile develop at the same time.

What causes an anal fissure?

Anal fissures are caused by injury (trauma) to the anal canal. Injury can happen if:
You pass a large stool that stretches the anal canal.
You are constipated and try to pass a hard stool.
You have repeated diarrhea.
Childbirth can also cause trauma to the anal canal.

What are the symptoms?

An anal fissure causes a sharp, stinging, or burning pain during a bowel movement. The pain, which can be severe, may last for a few hours.
Fissures may itch. They often bleed lightly or cause a yellowish discharge. You may see a small spot of bright red blood on toilet tissue or a few drops in the toilet bowl. The blood is separate from the stool. Very dark, tarry stools or dark red blood mixed with stool indicates some other condition, possibly inflammatory bowel disease (IBD) or colon cancer. You should contact a doctor if you have any bleeding with bowel movements.


Non-surgical treatments are recommended initially for acute and chronic anal fissures.These include topical nitroglycerin or calcium channel blockers, or injection of botulinum toxin into the anal sphincter. Other measures include warm sitz baths, topical anesthetics, high-fiber diet and stool softeners.

Surgery may be necessary if medicine fails to heal a tear (fissure) in the anus. The preferred procedure is lateral internal sphincterotomy. A doctor makes a small incision in the internal anal sphincter, one of two muscles that control the anus. This can be done as outpatient surgery under local anesthesia or general anesthesia.