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Fissure-in-ano

An anal fissure is a tear in the lining of the anus or anal canal (the opening through which stool passes out of the body). The fissure can be painful and may bleed.

Signs & Symptoms :

  • Pain during and even hours after a bowel movement.
  • Constipation.
  • Blood on the outside surface of the stool.
  • Blood on toilet tissue or wipes.
  • A visible crack or tear in the anus or anal canal.
  • Burning and itching that may be painful.
  • Discomfort when urinating, frequent urination or inability to urinate.
  • Foul-smelling discharge.

Causes :

Anal fissures can be caused by trauma to the anus and anal canal. The cause of the trauma can be one or more of the following:

  • Chronic constipation.
  • Straining to have a bowel movement, especially if the stool is large, hard, or dry.
  • Prolonged diarrhea.
  • Anal sex or anal stretching.
  • Insertion of foreign objects into the anus.

Other causes of anal fissures (other than trauma) include:

  • Longstanding poor bowel habits.
  • Overly tight or spastic anal sphincter muscles (muscles that control the closing of the anus).
  • Scarring in the anorectal area.
  • Presence of an underlying medical problem : such as Crohn’s disease and Ulcerative colitis [types of inflammatory bowel disease], anal cancer, leukemia, infectious diseases (such as tuberculosis), sexually transmitted diseases (such as syphilis, gonorrhea, Chlamydia, chancroid, HIV).
  • Decreased blood flow to the anorectal area.

Anal fissures are also common in women after childbirth and in young infants.

How is an anal fissure diagnosed?

Usually your doctor can diagnose an anal fissure by visual inspection of the anus or by gentle exam with the tip of the finger.