Anal Fissure

What is Anal Fissure

• Anal fissure is a small tear or crack in the skin around the opening of the butt (anus). Bleeding from the tear or crack usually stops on its own within a few minutes.
• A generally painful rip or tear in the sensitive anoderm of the anal canal. Most anal fissures are located in the posterior (90%) or anterior (10%) midline of the anal canal.
• The bleeding may happen every time you poop (have a bowel movement) until the tear or crack heals.

What are the signs of a chronic anal fissure? What do they imply? 

A chronic anal fissure can be identified by the presence of a sentinel pile (skin tag or hemorrhoid), anal ulcer (with fibropurulent material or visible internal sphincter muscle in the base), and a hypertrophied anal papilla arising from the dentate line. A chronic anal fissure usually does not respond to conservative treatment, and surgical intervention is in order.

What disorders should be considered in patients with laterally situated anal fissures? 

Disorders to consider are Crohn’s disease, ulcerative colitis, syphilis, tuberculosis, leukemia, carcinoma, and acquired immunodeficiency syndrome.

How are acute fissures managed? 

Conservative treatment consists of stool softeners and bulk agents to avoid hard bowel movements, sitz baths to help decrease sphincter spasm, topical anesthetics, and topical steroids. Topical nitroglycerin or nifedipine ointment reduces anal spasm. Injection of botulinum toxin also has been used to relax the anal sphincter.

Which surgical procedures are available for treatment of a chronic anal fissure? 

Open or closed lateral internal sphincterotomy, excision (ulcerectomy), excision and Y-V or other anoplasty, or anal dilation.

Follow these instructions at home:

Eating and drinking

• Avoid bananas and dairy products. These foods can make it hard to poop.
• Drink enough fluid to keep your pee (urine) clear or pale yellow.
• Eat a lot of fruit, whole grains, and vegetables.

General instructions

• Keep the butt area as clean and dry as you can.
• Take a warm water bath (sitz bath) as told by your doctor. Do not use soap.
• Take over-the-counter and prescription medicines only as told by your doctor.
• Use creams or ointments only as told by your doctor.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• You have more bleeding.
• You have a fever.
• You have watery poop (diarrhea) that is mixed with blood.
• You have pain.
• You problem gets worse, not better.

Anal Fissure, Pediatric

An anal fissure is a small tear or crack in the skin around the opening of the butt (anus). Bleeding from the tear or crack usually stops on its own within a few minutes. The bleeding may happen every time your child poops (has a bowel movement) until the tear or crack heals.

Follow these instructions at home:

Eating and drinking

• Have your child avoid foods and fluids that can make it hard to poop. These include:
  • Milk.
  • Other dairy products.
  • Bananas.
• Have your child drink enough fluid to keep his or her pee (urine) clear or pale yellow.
• Have your child eat foods that are high in fiber. These foods include vegetables, beans, and bran cereals.
• Have your child eat fruit (other than bananas).
• Have your child drink juice from prunes, pears, and apricots.

General instructions

• Make sure your child keeps the butt area as clean and dry as possible.
• Help or have your child bathe in warm water to help with healing. Do not use soap on the area around the opening of the butt.
• Give over-the-counter and prescription medicines only as told by your child’s doctor.
• Help or have your child put lubricating jelly on the area around the opening of the butt. This may help lessen pain when going to the bathroom.
• Avoid putting a thermometer in the butt (rectal thermometer). Avoid using medicines that are placed in the butt (suppositories). Avoid these things until the fissure has healed.

Contact a doctor if:

• Your child is bleeding more.
• Your child has a fever.
• Your child has watery poop (diarrhea) that is mixed with blood.
• Your child has other signs of bleeding or bruising.
• Your child has pain.
• Your child’s problem gets worse, not better.