What is an anal fissure?

An anal fissure is a small tear or split in the skin that lines the anus. Your anus is the hole in your bottom where faeces (poo) leave your body.

Anal fissures are very common. They can happen to people of any age.

If you have pain and discomfort when doing a bowel motion (poo) you might have an anal fissure.

An anal fissure can be very uncomfortable. But it will usually get better if you make some changes to your diet and use some simple treatments.

What are the symptoms of an anal fissure?

If you have an anal fissure, you will have pain with defecating (pooing). This pain can last for up to 2 hours. The pain is due to:

• tearing of the anal fissure
• spasm of your anal sphincter muscle

You may also have some symptoms, such as:

• cramping around the anus
• blood on the stool (poo) or toilet paper after wiping your bottom
• itchiness around your anus
• a small crack or tear in the skin around the anus
• a small skin tag or lump near the anal fissure

What causes an anal fissure?

Most anal fissures are caused by trauma (injury) to the area. This can happen:

• when you pass hard or large stools — for example, if you are constipated
• if you have diarrhoea
• during childbirth

Other, less common causes of anal fissures are:

• inflammatory bowel disease — especially Crohn's disease
• infection with tuberculosis
• sexually transmitted infections (STIs)
• cancer

When should I see my doctor?

You should see your doctor if:

• you feel pain when you are doing a poo
• there is blood on your stool
• there is blood on the toilet paper

When to seek urgent care

You should seek urgent medical care if you have symptoms, such as:

• dark red or black poo that is very smelly
• pain in your abdomen (belly)
• signs of shock — increased heart rate, cold clammy skin, confusion or vomiting
• fever

How is an anal fissure diagnosed?

Your doctor will ask about your symptoms and check your anus.

Your doctor may refer you to a colorectal surgeon if the cause of your symptoms is unclear, or your treatment isn't working.

How is an anal fissure treated?

Self-care

Most anal fissures will heal on their own. Self-care treatments aim to:

• reduce constipation
• relieve the pain
• heal the fissure

Your doctor may recommend eating lots of high-fibre foods and drinking extra water to soften your stools (poos).

Your doctor may also recommend:

• a stool softener
• warm baths or sitz baths

These treatments are safe and have few side effects.

If needed, you can also use pain relief medicines.

Self-care treatments usually work in 6 to 8 weeks. Self-care works for more than 8 in 10 people with an anal fissure.

Medicines

Your doctor may prescribe a medicine for your anal fissure.

Your doctor may prescribe glyceryl nitrate (GTN) cream to help relax your anal sphincter and reduce your pain. GTN cream can cause side effects such as headaches and light-headedness (feeling dizzy). Speak with your doctor or pharmacist if you notice these or other side effects.

If GTN doesn't work, your doctor may prescribe a medicine called a calcium channel blocker.

Botox is another treatment option. It's a chemical that's injected into the muscles around your anus to help them relax. It's recommended for people who have a high chance of developing faecal incontinence from surgery.

Botox usually lasts for 2 to 3 months. This allows the fissure to heal.

Surgery

Your doctor may recommend surgery if other treatments have not worked.

Anal fissure surgery is known as a lateral internal sphincterotomy. A small cut is made in your sphincter muscle, which to help it relax. You can have this procedure done as day surgery.

What are the complications of anal fissures?

Anal fissures can sometimes reoccur (come back).

About 4 out of 10 cases of anal fissures can become chronic (long term) fissures. If the split doesn't heal well, it can cause a small ulcer to form.

Can anal fissures be prevented?

You can prevent anal fissures by eating a diet that's high in fibre. This can also help stop an anal fissure from happening again.

You can also:

• exercise regularly
• drink lots of water
• not ignore the urge to poo — this can make your poo dry out and become harder to pass

Resources and support

The Queensland Government has resources about healthy toilet habits and increasing your fibre intake.

The Royal Women's Hospital has a useful factsheet about preventing constipation.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.