Anal Fissure

Common Signs and Symptoms

Early on, there may be burning and some pain in the anus while having a bowel movement.

• With repeated bowel movements there is a sensation of tearing.  The pain during and after a bowel movement can be very severe. Some describe it as a “hot poker” sensation.

• There may be bright red blood on the toilet tissue as you wipe, or on the surface of the stool, or in the toilet bowl.

• Patients with an anal fissure often become afraid of the pain that will follow a bowel movement, so they tend to hold back the bowel movement. This lets the stool become overly dry and even harder.  As the bowel movement finally passes, it reopens the fissure, worsening the condition.

Diagnosis

• Anyone with the above signs and symptoms should be checked for an anal fissure.

• Usually, the diagnosis can be made by taking a detailed history and doing a thorough physical examination.

• Often careful separation of the buttocks will show the lower or outermost portion of the fissure. It is usually located on the back side (posterior) of the anus. Sometimes there is a small tag of scar tissue at the lower end of the fissure.

• During gentle anal-rectal examination, the pain may be reproduced when the fissure is touched.

• Anoscopy: This is done with a hollow instrument approximately the size of your thumb (called an anoscope). While lying on your side on the examining table, the lubricated anoscope is gently inserted into the anus and the area carefully examined.

Treatment

About one third of anal fissures will heal if the following directions are followed:

• A diet that has enough roughage (fiber) and plenty of liquids in it so that the stools are soft and easy to pass.

• Stool softener (example: Colace, Senokot), fiber products such as Metamucil, Benefiber or Citrucel, or a mild laxative (example: Milk of Magnesia).

• Tub baths: Sitting in a bathtub filled with enough warm-hot (not burning) water and a ½ cup of Epsom salts to cover your anal area for 15 minutes three times a day and, if possible, after each bowel movement.

• If the fissure does not respond to the above treatment after a month or so it may become chronic.  At that point your surgeon may recommend an operation to help the fissure heal.

Home Care

• Take pain medication only as prescribed (narcotics may be constipating).

• Avoid constipation or constipating foods such as cheeses, meats, starches, etc.

• Avoid alcoholic beverages, spicy foods, and fatty foods.

• Avoid nuts, seeds, and kernel corn.

• Increase fluid intake with juices or water.

• Avoid straining to have a bowel movement. Wait until there is a natural urge but don`t delay once the urge occurs.

• Do not rub, itch, or heavily wash rectal area. Keep area clean and dry.

• Begin a high fiber diet.

• Soak in a tub full of very warm (not burning hot) water mixed with ½ cup of Epsom Salts.

• Carefully dry the rectal area with a patting towel motion or a hair dryer set on low or warm.

• Apply medication to outside and inside rectum three times daily and after each bowel movement using Analpram HC 1% or 2.5% or Nupercainal Ointment.

Anal Fissure Brochure

Please click on the following link to view a printable version of Cheboygan Surgical Associates' "Anal Fissure" Brochure.

File Download: Anal_Fissure_Final.pdf