Anal Fissures

Anal fissures are small tears or cracks in the lining of the anus that cause pain, bleeding and/or itching, especially after a bowel movement. Occurring in men and women of all ages, fissures result from the stretching of anal mucosa beyond its normal capacity. Once a cut or tear occurs, it leads to repeated injury. Fissures that are new are referred to as acute. If they do not heal, they may become a constant or chronic problem.

Board certified colon and rectal surgeons at Brigham and Women’s Hospital (BWH) offer the most advanced and effective treatment for patients with anal fissures, including lifestyle recommendations, medication management and minimally invasive surgery such as sphincterotomy, a technique that releases pressure inside the anus and promotes healing of anal tissues.

People who have had previous anal surgery and those with Crohn’s disease or ulcerative colitis may be more susceptible to anal fissures. Learn more about anal fissures.

Anal Fissures Topics

Diagnosis of Anal Fissures

Your surgeon will ask about your medical history, and will perform an examination of the anal region. Anal fissures are typically visible to the eye.

Treatment for Anal Fissures

Depending upon the severity of your anal fissure, your colorectal surgeon will recommend an individualized treatment plan which can help relax the anal sphincter and promote healing.

Non-Surgical Treatments

  • Medications such as nitrates or calcium blockers
  • Stool softeners such as fiber supplements
  • Steroid creams to relieve discomfort
  • Botox injections to relax spasms
  • Changing your diet to increase fiber and water
  • Taking warm baths for up to 20 minutes a day

Surgical Treatment

People whose anal fissures do not heal well may have an imbalance in anal pressure that prevents blood from circulating normally through the blood vessels around the anus. If symptoms persist, surgical treatment may be necessary:

  • Lateral internal sphincterotomy A small portion of the distal internal sphincter is cut and divided to relieve chronic spasm. The procedure is successful in curing chronic anal fissures. Changes in continence can occur, so it is reserved for patients who have failed non-surgical treatments.
  • Fissurectomy Excision of the fissure
  • Anal advancement flap Covering the fissure with tissue from another part of the body
  • Anal dilation Rare procedure that widens and stretches the anal canal

Read instructions for fleet enema preparation for anal surgery.

Read instructions for laxative and fleet enema mini prep for anal surgery.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have anal fissures and if surgery is needed. Careful monitoring and the involvement of an experienced colon and rectal surgeon are important to the successful outcome for patients with colorectal conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in anal fissure surgery. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues who have extensive experience in diagnosing and treating anal fissures. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Resources

Go to our health library to learn more about anal fissures.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.

Access a complete directory of patient and family services.

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