Anal fissure


An anal fissure is a split in the skin of the lower part of the anal canal. It probably starts as a simple tear and is not necessarily associated with constipation, as most patients have normal bowel activity, and sometimes a tendency towards looseness of stools.

It is also possible that a piece of sharp undigested food or violent diarrhoea can cause a fissure.

Anal Fissure Symptoms

The commonest symptoms of anal fissures are pain at defecation, bright bleeding which may be on the toilet paper or in the toilet and anal irritation. The condition can wax and wane in severity.

Anal Fissure Treatment

Most acute fissures will settle down with conservative (non-operative) treatment, which may include stool softeners, appropriate ointment (such as Rectogesic or Diltiazem Gel) and warm baths. Oral analgesics are also helpful.

Botulinum toxin injections will also sometimes achieve a cure.

  • If the fissure symptoms are chronic then usually a minor anal operation will be required. This procedure is termed a limited sphincterotomy, which involves dividing a small portion of one of the muscles around the anal canal (the internal sphincter). This is usually done as a day case, with no overnight stay required. The operation is almost always successful. Complications are very unusual but require informed discussion with Professor Adrian Polglase
Fact sheet in PDF format view download