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An anal fissure is a small tear or open wound in the tissue of the anus and it can cause pain and/or bleeding during a bowel movement. An anal fissure can develop in anyone, regardless of gender and age, but is most common in infants and small children due to constipation.

Stool that is too big or too hard.
Chronic constipation or diarrhea.
Vaginal childbirth.
Inflammatory bowel disease (IBD) or Crohn’s disease.
Reduced bloodflow to the anus.
Contraction of the sphincter.
Various diseases, such as rectal cancer, HIV (human immunodeficiency virus), tuberculosis, syphilis, though these are rare.

Infants and small children.
Elderly.
Constipation.
Vaginal childbirth.
Patients suffering from Crohn’s disease.
Anal intercouse.

A visible tear or wound around the anus.
Anal pain or burning, sometimes severe, during bowel movements.
Pain after bowel movements that can last up to several hours
Blood on the stool or toilet paper after a bowel movement.
Itching or irritation around the anus.
A small bump or skin tag on the skin near the anal fissure.

Patient history and symptoms, including toileting habits.
Physical examination of the anus where the doctor may use a gloved finger to feel inside the anus or use an anoscopy.
Laboratory tests to diagnose other problems, such as syphilis or HIV.

Caring for yourself and changing your behaviors to make bowel movements easier.
- Eat more high-fiber foods and drink plenty of water.
- After passing stool sit in warm water to stimulate blood circulation to the anus and to help the sphincter relax. Do this 2-3 times a day for 10-20 minutes each.
- Exercise regularly to move your bowels and promote regular bowel movements.
- If constipation is severe, take fiber supplements, laxatives, or stool softeners, as recommended by the doctor.
Medication
- Topical medication to alleviate pain.
- Medication to relax the sphincter, such as nitroglycerins or injecting Botulinum toxin.
- Antibiotics if the wounds become inflamed or infected.
Surgery
- Lateral internal sphincterotomy to release the sphincter muscles to alleviate pain when passing stool; bowel movements will be easier and the wound will heal more quickly.

Keep the anus and surrounding area clean and dry.
Drink plenty of water and eat high-fiber foods.
Exercise regularly to stimulate the digestive system.
If you have diarrhea, treat it as soon as possible.
In infants, change their diapers often to prevent irritation that can develop into wounds.

Created When: January 19, 2021

Last modify: December 23, 2022

Bumrungrad Hospital

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