Anal Fissure Symptoms & Treatment

An anal fissure is a small tear in the lining of the anus.  During bowel movements, people with this condition may experience a sharp, stinging or burning pain described as being akin to “passing a shard of glass.”  The often lingering pain can be so excruciating that some people try to avoid using the bathroom.  That only worsens things, unfortunately.

Other symptoms include small amounts of bright red blood (on toilet tissue or inside the toilet bowl), itching, irritation, discomfort while walking or exercising, and increased flatulence.  The fissure usually progresses through various phases of severity as it attempts to heal, and rough wiping or rubbing of the area can aggravate symptoms.

In many cases, anal fissures are caused by attempting to pass a hard, dry piece of stool while constipated.  Other causes include excessive tension in the two anal sphincters (muscular rings), stress, diarrhea, Crohn’s disease, inflammation of the anorectal canal, and childbirth.  Research shows that 11% of women develop fissures while giving birth.

Affecting men and women of all ages, anal fissures are characterized as acute (recent onset) or chronic (recurring frequently over an extended period of time).  Acute fissures may heal in a few days or weeks while chronic fissures may recur for months or years.  Medical treatment is often required to resolve a chronic fissure for good.

Don’t just live with the pain that makes having a bowel movement a dreaded event.   Find out what steps you can take to help your fissure heal properly…and permanently.

Anal Fissure Treatments

Approximately 80-85% of all anal fissures can be resolved with home treatments and the physician-supervised use of nitroglycerin ointment.  This is the least invasive and least expensive remedy available.  Risks associated with nitroglycerin ointment may include headaches, lightheadedness, itching and burning.

If a chronic fissure fails to respond to our standard therapy with nitroglycerin or calcium channel blockers, two other options exist. Both of these methods specifically focus on relaxing the internal anal sphincter (the one we cannot consciously control).  The difference is whether it’s temporary or permanent. Medication for erectile dysfunction (Viagra, Cialis) should not be taken with nitroglycerin.

Botox (Botulinum Toxin)

An injection of Botox into the internal anal sphincter can improve healing by temporarily paralyzing the muscle, which lowers resting pressure and reduces muscle spasms.  Risks may include pain from the injection, infection, hematoma (pooling of blood in the tissue) and temporary loss of control of gas or, more rarely, stool.

Surgery (lateral internal Sphincterotomy)

Lateral internal sphincterotomy is an outpatient surgery in which the surgeon makes a small incision in the internal anal sphincter.  Like Botox, this promotes healing by decreasing resting pressure and spasms, but the effects are permanent.  Risks may include pain, bleeding, infection and a lifelong loss of control of gas or, more rarely, stool.