An anal fissure is a tear or rip in the lining of the anus. Fissures are common and can sometimes be mistaken for other anal conditions, such as haemorrhoids.

The pain from an anal fissure often feels like passing pieces of broken glass during a bowel movement. Other typical symptoms include a burning sensation and a small amount of bright red bleeding during bowel movements.

If the fissure becomes chronic (lasting more than six weeks), a small lump or anal skin tag may develop near the fissure, leading to itching or irritation. Chronic or persistent fissures may also be linked to underlying medical conditions, such as inflammatory bowel disease (IBD), infections like chlamydia, or even a submucosal abscess.

Causes of Anal Fissures

• Passage of hard or large stools, which can stretch or tear the anal skin

• Chronic diarrhoea or constipation, leading to frequent straining

• Childbirth, which may cause trauma to the anal area

• Anal intercourse or other direct trauma to the anus

• Increased anal pressure from obesity or heavy lifting

• Certain medical conditions, such as inflammatory bowel disease (e.g., Crohn's disease)

Treatment Options

Fresh or recent anal fissures typically heal within a few days to weeks with proper preventive care. Initial treatments focus on lifestyle modifications and medications if necessary:

• High-Fiber Diet: Aim for 25-35 grams of fiber per day to soften stools and make them easier to pass. Drink plenty of water to prevent hard stools. Stool softeners may also help reduce pain during bowel movements.

• Avoid Straining: Place your feet on a small stool while sitting on the toilet to maintain a natural angle for bowel movements. Avoid delaying bowel movements when you feel the urge, as holding it in can worsen the fissure.

• Warm Sitz Baths: Soak in warm water once or twice a day, especially after bowel movements, to relax the anal sphincter muscles.

• Topical Medications:

  • Pain relief: Lidocaine gel or xylocaine ointment can be applied around the anus.

  • Healing aid: Rectogesic or nitroglycerin ointments help relax the anal sphincter muscles, promoting healing.

Surgical Options

Most anal fissures heal without surgery, but chronic fissures (lasting longer than six weeks) may require surgical intervention. Chronic fissures are harder to treat because the anal tear does not heal properly.

The goal of surgery is to relax the internal anal sphincter muscles, reducing pain and spasms and allowing the fissure to heal effectively.

With the right care, relief from anal fissures is possible. If symptoms persist or worsen, consult a doctor to discuss the best treatment options for you.