An anal fissure, the most common cause of anal pain, is a small cut of tear in the lining of the anal canal. While common, fissures are often confused with other causes of pain and bleeding, such as hemorrhoids.
Symptoms of an anal fissure are pain and/or bleeding after a bowel movement. Pain may be so intense as to cause severe constipation from avoidance of having a bowel movement.
Anal fissures are caused by trauma, i.e., anything that can cut or irritate the inner lining of the anus - most typically a hard dry bowel movement - or diarrhea or anal inflammation. Anal fissures may be acute (recent onset) or chronic (present for a long time or recurring frequently). Chronic fissures often have a small lump known as a sentinel pile or skin tag.
Treating constipation or diarrhea can oftentimes allow a fissure to heal on its own. An acute fissure is typically managed conservatively, with over 90% healing without surgery. Conservative management of fissures include maintain a high fiber diet; bulking agents, stool softeners. Extra fluid intake will also help soften bowel movements, relieve constipation and allowing healing. Occasionally a topical muscle-relaxing cream is prescribed to relax the sphincter muscles.
Patients need to continue good bowel habits, including following a high fiber diet after a fissure has healed to prevent recurrence. If fissures recur without explanation, or fail to respond to treatment, further assessment may be warranted.
Surgery is a very effective treatment of a fissure and recurrence rates after surgery are low. Surgery usually consists of a small outpatient operation to cut a portion of the internal anal sphincter muscle. If a skin tag is present, it too may be removed to promote healing of the fissure. After surgery, complete healing occurs in a few weeks, although pain often disappears after a few days.
There is also a multistep approach to the healing of fissures that does not require surgery.
Fissures do not lead to colon cancer. Persistent symptoms, however, need evaluation since other conditions cause similar symptoms. Even if you fissure has healed, your doctor may want to perform additional testing, including a colonoscopy to exclude other causes of bleeding.