Anal Fissure

An anal fissure is a small tear or split in the lining of the anus. Although the condition can be quite painful, it is very common and affects people of all ages. Many people feel embarrassed discussing symptoms with their doctor, but an anal fissure is a recognised medical condition that responds well to treatment. Understanding what causes it, how it is diagnosed, and what can be done about it helps you take the right steps towards recovery.

How the anus works

The digestive system processes food and moves waste through the large intestine by waves of muscular contractions. This waste is temporarily stored in the rectum before being expelled through the anus. The anus itself is a short passage lined with a thin, sensitive membrane called the anal mucosa. A muscular ring known as the sphincter controls the opening and closing of the anus during a bowel motion. When the anal mucosa tears, the result is an anal fissure.

What causes an Anal Fissure?

Most anal fissures result from physical trauma to the anal area. Chronic constipation is one of the most common triggers, particularly when stools are dry, hard, or large and require significant straining to pass. Diarrhoea can also cause fissures, as repeated loose bowel motions irritate and weaken the delicate lining of the anus.

Other causes include trauma associated with childbirth, rough or excessive wiping after a bowel motion, inflammation of the anus and rectum, and conditions such as Crohn’s disease. Less commonly, anal fissures may be associated with infection, anal injury, or rectal cancer. The condition is particularly prevalent in infants and young children, though the tendency to develop fissures generally decreases with age.

Recognising the symptoms

Pain is usually the first and most prominent symptom of an anal fissure. This pain typically occurs during a bowel motion and may continue for some time afterwards. The discomfort arises from tearing of the fissure itself and from spasm of the sphincter muscle surrounding the anus.

You may also notice bright red blood on the surface of stools, on toilet paper after wiping, or in the toilet bowl. Some people experience itchiness around the anus, cramping, or notice a small skin tag or lump near the site of the tear. If you observe blood in your stool or experience pain when passing a bowel motion, it is important to consult your doctor so the cause can be properly assessed.

When to see a doctor

You should seek medical advice if you have pain when passing a bowel motion, notice blood on your stool, or blood on your toilet paper. While an anal fissure is generally not associated with more serious diseases such as bowel cancer, some conditions including cancer of the anus can present in a similar way. Accurate diagnosis is essential to ensure you receive appropriate care.

Your GP will ask about your symptoms and examine the anal area. In some cases, a referral to a gastroenterologist or colorectal surgeon may be recommended, particularly if the cause of your symptoms is unclear or if initial treatment has not been effective.

Diagnosing an Anal Fissure

Diagnosis is usually straightforward and is based on a physical examination of the anus. In some cases, your doctor may use a slender instrument called an anoscope to examine the anal canal more closely. This allows a clear view of the fissure and helps rule out other conditions that may be causing your symptoms.

Treatment options

The good news is that many anal fissures heal without the need for surgery. Treatment is generally approached in stages, beginning with the most conservative measures and progressing to more involved options only when required.

Conservative management

For most people, changes to diet and bowel habits are the foundation of treatment. Eating a diet high in fibre, drinking six to eight glasses of water each day, and using a stool softener where appropriate all help to reduce the pressure on the fissure during bowel motions. Warm sitz baths, where you sit in a shallow bath of warm water for around twenty minutes, can soothe discomfort and assist healing. Applying petroleum jelly to the area and using baby wipes rather than toilet paper are also helpful. These conservative measures are effective for the majority of people and typically produce results within six to eight weeks.

Medication

When conservative measures alone are not sufficient, your doctor may prescribe medication to assist healing. Certain creams applied to the anal area help reduce muscle spasm and improve blood flow to the fissure, which supports the healing process. Botulinum toxin injections into the sphincter muscle are another option, working to relax the muscle and allow the fissure to heal over a period of two to three months. This approach is particularly suitable for people who may be at higher risk of complications from surgery. Pain relief medication may also be recommended to manage discomfort during treatment.

Surgery

Surgery is considered when other treatments have not resolved the fissure. The most common procedure is a lateral internal sphincterotomy, which involves making a small cut in the sphincter muscle to relieve tension. This can be performed under local anaesthetic as day surgery. The procedure removes the fissure and any associated scar tissue, and does not affect normal sphincter control. Around nine out of ten people who undergo this procedure do not experience a recurrence.

Possible complications

While many anal fissures resolve with appropriate care, some can become chronic if the tear repeatedly reopens before it has the chance to heal fully. Over time, this can lead to the formation of scar tissue at the site of the fissure, a condition known as a sentinel pile. In some cases, the fissure may give rise to additional complications such as an anal fistula, where an abnormal channel forms between the anal canal and surrounding tissue, or anal stenosis, where the anal canal becomes abnormally narrow as a result of muscle spasm or scarring. These complications underscore the importance of seeking timely medical advice and following through with recommended treatment.

H2: Preventing Anal Fissures

Many anal fissures can be avoided by maintaining good bowel health. A diet rich in fibre from fruit, vegetables, wholegrains, and legumes helps produce soft, regular stools that pass without straining. Drinking adequate water throughout the day is equally important. Where dietary changes alone are insufficient, a fibre supplement may be of benefit. Avoiding the urge to delay a bowel motion is also advisable, as holding on can cause stools to dry out and become harder to pass. Gentle wiping after each bowel motion helps minimise trauma to the anal area.

Seeing a gastroenterologist in Brisbane

If you are experiencing symptoms consistent with an anal fissure, or if your symptoms have not improved with initial management, we encourage you to speak with your GP about a referral to see one of our experienced gastroenterologists.

Our gastroenterologists are experienced in the diagnosis and management of conditions affecting the gastrointestinal tract and can guide you through the most appropriate treatment pathway for your individual circumstances.

If you have received a referral to see one of our doctors, you can request an appointment online, or contact our rooms directly on (07) 3321 1500.

This information has been sourced and adapted from education resources developed by

• Health Direct Australia (Health Direct)
• Better Health Channel Victoria (Better Health Channel)