Anal fissures are cracks or tears in the anus and anal canal. They may be acute or chronic.
Anal fissures are caused primarily by trauma, but several non-traumatic diseases are associated with anal fissures and should be suspected if fissures occur in unusual locations.
The primary symptom of anal fissures is pain during and following bowel movements. Bleeding, itching, and a malodorous discharge also may occur.
Anal fissures are diagnosed and evaluated by visual inspection of the anus and anal canal. Endoscopy and, less commonly, gastrointestinal X-rays may be necessary.
Anal fissures are initially treated conservatively by adding bulk to the stool, softening the stool, consuming a high fiber diet, avoiding "sharp" or poorly digested foods, and utilizing sitz baths.
Ointments containing anesthetics, steroids, nitroglycerin, and calcium channel blocking drugs (CCBs) are used for treating anal fissures that fail to heal with less conservative management.
Injections of botulinum toxin may be effective when ointments are not effective. (The cost of treatment would be substantially reduced if the toxin were packaged in smaller doses.)
Surgery by lateral sphincterotomy is the gold standard for curing anal fissures. Because of complications, however, it is reserved for patients who are intolerant of non-surgical treatments or in whom non-surgical treatments have proven to be ineffective.
Medically Reviewed by a Doctor on 6/25/2014
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