Anal Fissure: Symptoms, Causes & Treatment
الشق الشرجي
An anal fissure is a small tear in the lining of the anus causing sharp pain during and after defecation with bright red blood. It is usually caused by constipation and hard stool. Most cases heal with more fiber, fluids, and topical creams, and chronic ones may need additional treatment.
What is Anal Fissure?
An anal fissure is a small tear or split in the membrane lining the anal canal (the last part of the digestive tract). Despite its small size, it causes severe pain because this area is rich in sensory nerves.
The most common cause of an anal fissure is the passage of hard, large stool during constipation, which tears the thin lining; it may also occur due to chronic diarrhea or childbirth. It is characterized by a sharp, cutting or burning pain during defecation that continues for minutes or hours afterward, often accompanied by bright red blood on the stool or toilet paper. The patient may enter a vicious cycle: the pain makes them avoid defecation, so constipation worsens, the stool gets harder, and the fissure worsens.
Most anal fissures are acute and simple and heal within a few weeks once constipation is treated and the stool softened. Treatment relies mainly on increasing dietary fiber and fluids to soften the stool, warm (sitz) baths to relax the muscle and ease pain, and topical creams that aid healing. Chronic fissures lasting more than six weeks may need additional treatments prescribed by the doctor. It is important to see a doctor because any rectal bleeding should be evaluated to ensure there are no other causes.
Symptoms
- Sharp, cutting or burning pain during and after defecation.
- Bright red blood on the stool or toilet paper.
- Itching or irritation around the anus.
- Spasm of the anal muscle.
Causes
- Passage of hard, large stool during constipation (most common).
- Chronic diarrhea.
- Childbirth and straining during defecation.
- Sometimes inflammatory bowel diseases.
Diagnosis
- Clinical examination of the area, which usually reveals the fissure.
- Evaluation to rule out other causes of bleeding when needed.
Treatment
Conservative treatment (most cases)
- Increasing fiber and fluids and softening the stool to treat constipation.
- Warm (sitz) baths to relax the muscle and ease pain.
- Topical creams that aid healing and ease spasm.
Chronic fissure
- Additional treatments or a minor procedure prescribed by the doctor when conservative treatment fails.
This content is educational and does not replace consulting a surgery or gastroenterology specialist.
Complications
- Turning into a chronic non-healing fissure.
- Recurrence and the pain-constipation cycle.
- Chronic anal muscle spasm.
Prevention
- A fiber-rich diet and adequate water to avoid constipation.
- Not straining or sitting long on the toilet.
- Responding promptly to the urge to defecate.
When to see a doctor
See a doctor for severe anal pain, persistent bleeding, or a fissure that does not heal within weeks, as any rectal bleeding should be evaluated. Book an appointment with a general surgery or gastroenterology specialist on ClinicsJo for examination and a treatment plan.