Anal Fissure

Anal fissure is a tear of the skin or lining at or just inside the opening of the anus. The tear is most typically caused by passage of hard stool, although diarrhea or other trauma to the anal area may cause that too. Other less common causes include Crohn's disease and cancer. Fissures are broadly classified as acute vs chronic based on the duration of symptoms. The longer time the fissure left untreated, the more difficult it is to heal. Occasionally a deep fissure may lead to anal abscess and fistula.

Symptoms of anal fissure

The skin is very sensitive in the anal area, so even a small fissure can cause severe sharp burning pain, which is the most common symptom. Pain usually starts with stool passage and may last for few minutes to few hours afterwards. You may or may not have bleeding. When fissure gets deeper and the anal sphincter muscle is exposed and irritated, pain becomes throbbing/pulsating and can be overwhelming. Some people may try to avoid having a bowel movement because of the pain. There may be a small skin tag next to the fissure and could be mistaken as a hemorrhoid.

Diagnosis and treatment of anal fissure

Fissures can be diagnosed clinically by exam in the office. The exam may also exclude other conditions such as abscess, fistula or tumor, which may be missed by the untrained eyes. Treatment involves a combination of correcting the underlying cause (such as increasing fiber and water intake and bowel regimen to correct the constipation), and topical medications that help to ease the pain and relax the anal sphincter to help the fissure heal. An acute fissure often heals with the above, although it may take 6-8 weeks. If the fissure gets infected, antibiotics and/or drainage procedure may be needed. A chronic fissure especially the ones associated with abscess and/or fistula often needs outpatient surgical procedure to debride ("clean up") the fissure so it can heal. Dr. Choi sometimes employ other techniques such as Botox® injection or flap anoplasty (covering the fissure with healthy adjacent skin flap) for more difficult to treat fissure and avoid sphincterotomy (surgical division of the anal sphincter, a technique that was used sometimes but is associated with risk of fecal incontinence).

Prevention of anal fissure

Since fissure is often caused by constipation, diarrhea or known trauma, preventing the inciting causes can prevent the fissure from getting worse and prevent a healed fissure from recurring. You may or may not know what was the cause or what can be done. Dr. Choi can help you uncover the cause and give practical suggestions for your problem.

Helpful links:


*American Society of Colon and Rectal Surgeons