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Anal Fissure

The anus is lined with a thin, delicate tissue called mucosa. An anal fissure is when a tear occurs along the lining, usually toward the end of the anus. Anal fissures are very common in infants but can affect people of any age. 

Many anal fissures gradually heal on their own or improve with simple treatments, e.g., increased fiber intake, stool softener, proper hydration, sitz bath. However, if symptoms worsen, a colorectal specialist should be seen as medication or occasionally surgery may be needed.

Causes

Most anal fissures result from straining too hard during a bowel movement. If the stool is particularly large or has hardened, it can be difficult to pass through the anus without tearing the mucosa. Other common causes include constipation, chronic diarrhea, anal intercourse, and childbirth. 

Frequent tearing of the mucosa may signal a more serious condition, e.g., Crohn’s disease, ulcerative colitis, a sexually transmitted infection, HIV, tuberculosis, leukemia, or even anal cancer

Symptoms

It can be difficult to detect an anal fissure due to location. Some signs associated with the condition are:

  • Pain during bowel movements
  • Pain after bowel movements lasting up to several hours
  • Visible opening in the lining of the anus
  • Brightly colored red blood on the stool or toilet paper following a bowel movement
  • Burning or itching sensation of the anus
  • Constipation
  • Foul-smelling discharge
  • Lump on the skin near the fissure
  • Spasms in the anal sphincter (ring of muscle at end of anus)

Diagnosis 

Our doctors diagnose a fissure during a physical exam of the anal region. Often the tear is visible so that is all that is needed for diagnosis. If the fissure occurs on the side of the anal opening versus the back or front, it may be a sign of another condition. Further testing may be recommended, e.g., anoscopy, flexible sigmoidoscopy, or colonoscopy

Treatment

Although many recover from an anal fissure without professional intervention, it is important to ensure the condition does not worsen.  Our physicians attempt to heal anal fissures using minimally invasive methods, e.g., lubrication with petroleum jelly/zinc oxide ointments/glycerin suppositories to ease passing of stool, regular sitz baths to cleanse the tissue and relax anal muscles, topical medications such as benzocaine or lidocaine, stool softeners, increased fiber and water intake.

Patients failing to heal or those with severe damage to the mucosa and muscles of the anus may need surgical treatment. If left untreated, damage can lead to recurring spasms of the anal sphincter, resulting in considerable pain and loss of control over anal muscles. A lateral internal sphincterotomy will surgically treat an anal fissure. An incision is made to the internal anal sphincter to relieve tension with the muscle. Once pressure is alleviated, the anal fissure is more likely to heal. 

To reduce anal sphincter spasms and promote healing, doctors may inject the anal sphincter with botulinum toxin or have the patient apply nitroglycerin ointment or calcium channel blockers to the area of the fissure. If not successful, surgery may be needed to relieve sphincter spasms by cutting a portion of the internal sphincter (internal anal sphincterotomy).

Find an Office

Gladstone Office

6060 North Oak Trafficway
Suite 101
Gladstone, MO 64118
Phone: (816) 941-0800

Leawood Office

4370 W 109th St.
#350
Overland Park, KS 66211
Phone: (816) 941-0800

Overland Park Office

10100 W 87th St.
Suite 200
Overland Park, KS 66212
Phone: (816) 941-0800

Independence Office

19550 E 39th St
Suite 320
Independence, MO 64057
Phone: (816) 941-0800

Lee’s Summit

1980 SE Blue Parkway
Suite 2330
Lee’s Summit, MO 64063
Phone: (816) 941-0800