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Anal Fissures

Anal fissures are abnormal cracks or tears in the anus skin that often extends internally from the anal opening into the anal cavity, under the trunk (between the legs) and towards the genetalia. A study of the human anatomy reveals that this part of the anal wall is relatively. Anal fissures or tears usually result in rectal bleeding and pain, particularly after defecation.

Since most anal fissures are the result of stretching of the anal mucosa beyond its limit, they will sometimes heal on their own when the stretching is minimized. However this may not always be the case; spasms of the internal sphincter muscle may cause chronic tearing or fissures. Spasms can not only tear the walls and mucosa, but actually prevent blood from reaching the area and therefore inhibits the mucosa from its ability to heal itself. The resulting ulcer must be addressed by a physician or surgeon for it to heal completely.

Anal fissures are common in women after childbirth. Further, they may also be caused by anal intercourse and difficult bowel movement due to constipation. Children who suffer from constipation are also at risk of anal fissures. Congenital anal fissure, although fairly uncommon, can be found among newborns as well, usually due to an anomaly or illness while in the womb that causes fistulas or other abnormalities.

It is important to note that other inflammatory diseases such as IBD may cause anal fissures as well. If anal fissures persist, it is recommended you see a physician for a proper diagnosis.


Anal fissures have well defined symptoms. For example, bright red bleeding after defecation is an indicator that you may have an anal fissure. Pain is usually associated with any activity that puts any stress or pressure on or around the anus. In most cases, the pain will be noticeable enough that one will be able to ascertain the cause (for example, bleeding and pain immediately following constipation or child birth). More than 90% of anal fissures will heal on their own, however some may persist.

In some cases, anal fissures are accompanied by irritation or itchiness around the anal cavity. Because of this symptom, many people misdiagnose an anal fissure with a more common affliction, hemorrhoids. Although hemorrhoids and anal fissures are completely different, their symptoms are so similar that this confusion is to be expected. A couple ways of determining whether you have a hemorrhoid or an anal fissure are as follows: hemorrhoids can be external or internal – if you have a bump or lesion just outside the anus which is bleeding and causing pain, you probably have a hemorrhoid. Hemorrhoids also tend to be painful throughout the day where anal fissure pain usually decreases until stress if put on the anal cavity (a bowel movement for example). If you are unsure whether you have an internal hemorrhoid or anal fissure, it is best to see a physician for a proper diagnosis.

How to Prevent Anal Fissures

To help prevent the onset of an anal fissure, it is important to respond to your body in sickness (such as constipation and diarrhea). Here are a few examples:

• Take care of constipation. Always ingest fiber-rich food in your daily diet, and also include fruits such as banana which have laxative properties;
• Treat diarrhea as quickly as possible;
• If you have frequent constipation, lubricate the anal wall daily with a water based lubricant;;
• Use a dampened wipe instead of abrasive toilet paper;
• Although anal sex is an uncommon cause of anal fissures, it is important to refrain from this activity if you have had anal fissures before.

Anal Fissure Treatment

As far as the treatment of anal fissure is concerned, there are several theories, some of which contradict each other. While one group of experts are of the opinion that anal fissures should be rectified by surgery, another strongly opposes it by quoting examples where surgery has resulted in several after effects that include fecal incontinence where the patient involuntarily passes stool. To counteract the issue, Italian researchers in 1998 initiated injecting botulinum toxin into the anal sphincter with the idea that it will promote healing by way of relieving spasms through relaxation of the muscle. This of course only addresses fissures caused by muscle spasms.

From a surgical standpoint, sphincterotomy is often recommended for anal fissure treatment where conservative measures do not yield satisfactory result. The invasive procedure includes excising a part of the sphincter that has lost its elasticity and repairing the rest of it for proper functioning. “Tailored lateral sphincterotomy” selects the height of the sphincter to be divided with the aim of preserving more of the sphincter in the patient.

As with most inflammations and ailments, doctors tend to prescribe corticosteroids, or steroidal creams, to reduce inflammation and induce healing. There are many such creams available over the counter and through prescription. The problem with steroidal drugs is that we are seeing more and more people who are allergic to steroids and the list of side effects for steroidal prescriptions are getting longer each day (including the onset of brittle bones or osteoporosis).

As with most ailments, natural therapy is becoming more and more popular. This is because natural remedies are almost always safe, can have ‘side-benefits’ instead of ‘side-effects’ have high success rates (this is naturally contested by pharmaceutical companies!) and is relatively cheaper than prescription or surgery routes. Examples of natural remedies include witch hazel, chamomile, aloe vera, tea tree and other herbs with high vitamin E content. With natural healing becoming more popular, there is no need to become an expert – natural remedies for almost all ailments are now available on the internet or in health stores. In most cases natural remedies will remove the need for surgery or prescription drugs.


It is important to be in tune with your body and to investigate any abnormalities. Diagnosing your own ailments correctly is not only important for the sake of your well being, but also helps you listen to your body and understand when it fighting other ailments. However, it can never be stressed enough that a second opinion, especially from your physician, is always recommended. Your doctor can tell you what your particular ailment is, and suggest treatment. If you are not satisfied with a prescription and want to explore natural methods, speak to your doctor about this. At least you will have a proper diagnosis of the problem on which to work from.


Mayo Foundation for Medical Education and Research:


US National Institue of Health:


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