Anal Fissure

An anal fissure is a small tear in the lining of the anus, usually caused by passing a hard or large stool. It causes sharp pain, particularly during and after bowel movements, but most heal with simple treatment.

• Sharp, often severe pain during and for some time after a bowel movement
• Bright red blood on the stool or toilet paper
• A visible tear or crack in the skin around the anus
• Itching or irritation around the anus
• Spasm of the anal muscle, which can worsen pain and delay healing

• Most commonly caused by passing a hard, large, or dry stool, which stretches and tears the anal lining.
• Chronic constipation or diarrhoea can contribute.
• Childbirth can also cause anal fissures in some women.

• Usually diagnosed through a description of the characteristic sharp pain with bowel movements together with a gentle visual examination of the anal area.
• Further examination is generally avoided if it would cause significant pain, since the diagnosis is often clear from history and visual inspection alone.

Increasing dietary fibre and fluid intake to soften stool is central to treatment and prevention of recurrence.

A stool softener or mild laxative may be used to reduce straining during bowel movements while the fissure heals.

Warm sitz baths (sitting in warm water) several times a day, particularly after bowel movements, help relax the anal muscle and ease pain.

A topical medicine to relax the anal muscle may be used for fissures that do not heal with simple measures, helping improve blood flow to support healing.

Fissures that persist despite these measures may be referred for further assessment, as a small procedure can be considered for chronic, non-healing cases.

• Eat a high-fibre diet with adequate fluid intake to keep stools soft.
• Avoid straining during bowel movements.
• Respond promptly to the urge to have a bowel movement rather than delaying it.
• Maintain good anal hygiene without excessive wiping or cleaning, which can irritate the area.