Bleeding with bowel movements that result in bright red blood either on the toilet tissue or in the bowl
Small amounts of mucous may be present
Apprehension about bowel movement pain may cause you to delay bowel movements. This can make the symptom worse.
The doctor will ask about your symptoms and medical history. A physical exam will be done. Anal fissures are generally visible, so diagnosis can be made with an anal exam. If it is not visible, but suspected, your doctor may need to do other tests as long as it is not too painful. These tests include:
Digital rectal exam—to feel for any lumps or abnormalities
Anoscopy—examination of the anal canal with a scope
There is significant bright red bleeding in someone with an increased risk for
There are features suggesting a secondary anal fissure
Fissures usually occur in predictable locations around the anus. If there are multiple cuts, or a cut in an unusual location, the doctor may order additional tests to look for other conditions.
Treatment aims to heal the cut and prevent future anal problems. Most fissures heal on their own or with self-care. Fissures that are fairly new are easier to heal than ones that have persisted for longer than 3 months.
Fissures may heal by changing some of your daily habits. These include:
Warm sitz baths, especially after bowel movements, to help relieve pain and promote healing
Increasing dietary fiber intake
Increasing fluid intake
Using stool softeners or bulk laxatives
Your doctor may prescribe:
Topical medications to reduce pain and inflammation
Topical nitrates and calcium channel blockers to increase blood flow to the anus and promote healing
Injected botulinum toxin to relax tightened anal sphincter muscles
Surgery may be necessary for:
Fissures that do not heal with other treatment methods
Scar tissue or spasms in the anal sphincter muscles that may also delay healing
Surgical procedures include:
—A tiny incision is made in the sphincter muscle fibers to prevent spasms that result in straining during a bowel movement.
Fissurectomy—Excision of the fissure.
Anal advancement flap—Covering the fissure with tissue from another part of the body.
Anal dilation—Rare procedure that widens and stretches the anal canal.
To help reduce your chances of an anal fissure:
Drink plenty of fluids throughout the day
high in fiber, such as fruits, vegetables, legumes, and whole grains
Avoid straining during bowel movements
Follow your treatment plan if you have Crohn disease or ulcerative colitis
Anal fissure expanded innformation. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/abscess-and-fistula-expanded-information. Accessed December 18, 2017.
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