Anal Fissure
An anal fissure is a small tear in the skin lining the anus, usually caused by passing a hard stool. It is often called piles in Nigeria, but it is a different condition with a different treatment. The tear makes the anal muscle go into spasm, which reduces blood flow and stops it healing, so a fissure can last for months. Most heal with softer stools and a prescribed ointment that relaxes the muscle.
Find a General Surgery SpecialistMedically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
Symptoms
- Sharp, cutting pain during and after stooling
- Burning pain that can last an hour or more afterwards
- A streak of bright red blood on the stool or tissue
- Fear of going to the toilet because of the pain
- A small skin tag at the edge of the anus (in a long-standing fissure)
When to See a Doctor
See a doctor if stooling has been painful for more than a few days, or if you have any bleeding from the back passage. See a surgeon if a fissure has not healed after six to eight weeks of treatment. Fissures in an unusual position, or several at once, need investigation for other conditions such as Crohn's disease or infection.
Treatment options
- Fibre, water and stool softeners so stools pass without straining
- Warm sitz baths to relax the muscle
- Prescribed ointments that relax the anal sphincter (glyceryl trinitrate or diltiazem)
- Botulinum toxin injection into the sphincter
- Lateral internal sphincterotomy, a small operation for fissures that do not heal
Common Questions
How is a fissure different from piles?
Piles are swollen blood vessels and are usually painless unless thrombosed. A fissure is a tear and typically causes sharp pain with every bowel movement. Both can bleed. A doctor can usually tell them apart on a gentle examination.
How long does an anal fissure take to heal?
A new fissure often heals within a few weeks once stools are soft. One that has lasted more than six weeks is called chronic and usually needs a prescribed ointment, and sometimes a procedure.
Will surgery for a fissure affect bowel control?
Sphincterotomy heals most chronic fissures. A small number of people have some difficulty controlling wind or, rarely, stool afterwards, which is why ointments are tried first and the surgeon discusses the risk with you.
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