Anal fissures

An anal fissure is a tear in the skin of the anus which may extend to the muscle of the internal anal sphincter. When this happens, the muscle contracts and the tear will not heal up easily because it is open. Furthermore, faeces soil the wound and delay healing. This will cause pain for the patient.

Up to 20% of people may have anal fissure at some point in their lifetime.

What are the symptoms of anal fissure?

At the time it starts, the patient may feel a sharp pain during or after defaecation. This pain may be present for many hours. Light bleeding occurs and the patient may complain of blood stain on his faeces or toilet paper. Itching may occur, as well as a rash of the skin around the anus.

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What causes anal fissures?

  • Injury to the skin of the anus occurs when a person passes hard bulky stools that suddenly stretch the anus, especially when the person is straining. It also occurs with severe diarrhea
  • Crohn's disease
  • Inserting objects into the anus
  • Anal sex

How is a diagnosis of anal fissure made?

The doctor will take a history and examine the area around the anus, looking for a tear. If he cannot see any tear, the doctor may insert his gloved finger into your anus. He may also use a small instrument (in a procedure called anoscopy) to look at your anus.

Other tests that may be done include sigmoidoscopy or colonoscopy, especially if the patient is 50 years old or more.

Treatment of anal fissure

Anal fissures may heal spontaneously, and no further treatment may be necessary. However, if the anal fissure has not healed, the initial treatment aims at making sure that there is no constipation, stools are soft and patient feels less pain.

Conservative treatment

  • Drinking adequate amounts of water (8 to 10 glasses per day)
  • High-fiber diet e.g., fruits and vegetables, brown rice
  • Fiber supplements e.g., MetamucilĀ®
  • Laxatives
  • Sitz baths: sitting inside warm water for about 15 minutes
  • Analgesics e.g., paracetamol
Medical treatment: this involves the use of glyceryl nitrate, diltiazem or nifedipine to relax the anal sphincter, so that the wound can close and healing can occur.


Surgical options include lateral sphincterotomy, fissurectomy or anal advancement flap.

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Feel free to ask an Israeli doctor