Anal Fissures

An anal fissure is a small tear in the lining of the anus that can cause severe pain and bright red bleeding during or after a bowel movement. The primary cause of an anal fissure is a hard, dry bowel movement. Other causes of a fissure include diarrhea, anal receptive intercourse, and inflammation of the anorectal area.

At least 85 % of anal fissures heal by themselves or with non-operative treatment. Treatment includes:

  • High fiber diet with lots of fruits, vegetables, and grain
  • Daily fiber supplements such as Metamucil, Citucel, or Konsyl
  • Plenty of daily water intake
  • Soaking in a very warm bath for about 10 minutes 2–3 times per day
  • Daily stool softeners such as Colace or Miralax to help avoid constipation.
  • Avoid cheese, pasta, white rice, and white breads that can cause constipation.
  • Brown rice, whole wheat bread, and pasta are good.
  • Application of a special medicated cream

A fissure can take several weeks and sometimes months to completely heal. If conservative measures fail, the next line of treatment may be Botulinum Toxin (Botox) injections. Botox is injected directly into the internal sphincter muscle to promote anal sphincter relaxation and subsequent healing. This injection results in full healing in approximately 50-70% of patients.

The major reason that fissures do not heal is chronic muscle spasms of the internal anal sphincter. Surgery consists of cutting a portion of the internal sphincter muscle to break the spasm and allow the fissure to heal, as well as removing any scar tissue around the fissure. Cutting this muscle rarely interferes with the ability to control bowel movements, although 5-10% of patients develop occasional incontinence of gas and minor seepage of mucous. This minor procedure is performed as an outpatient. Complete healing occurs in a few weeks, although pain often resolves after a few days. Surgery is 95% successful.