Symptoms of an anal fissure resemble hemorrhoids. How do you recognize the disease, and how is it treated?

An anal fissure is a painful loss of the mucous membrane of the anal canal, often affecting young people. Treatment involves prevention of constipation, sitz baths, and soothing agents.

An anal fissure is a painful defect in the mucosa of the anal canal, affecting young people aged 20–40. 

The exact cause of these changes is not known, but it is known that anal fissures are related to, among others, to:

  • constipation, hard stools (often due to a low-fiber diet),
  • inflammatory bowel diseases,
  • previous anal surgeries,
  • trauma,
  • childbirth
  • anal intercourse.

Most fissures form on the posterior wall of the anus. 

What does an anal fissure look like?

An anal fissure is a paper cut in the mucosa covering the anus, usually visible to the naked eye. Chronic fissures are deeper and may also cause skin thickening as well as red and swollen skin. 

Symptoms of an anal fissure include:

  • pain in the anal area,
  • pain in the anus that worsens during defecation,
  • pain persists for many hours after defecation,
  • slight bleeding (blood on toilet paper)
  • burning, itching around the anus.

Anal fissures can be acute (symptoms last less than 6 weeks) or chronic (symptoms last more than 6 weeks). Without treatment, the disease can progress to the chronic stage, usually taking several weeks.

What should one do if an anal fissure develops? 

Contact your doctor if you have symptoms of an anal fissure, as it can be confused with hemorrhoids and anal cancer.

Diagnosis of the disease is based on a conversation and examination of the anal area, which may include digital rectal examination, rectoscopy, endoscopy, and biopsy to exclude cancer.

Anal fissure treatment

Treatment of anal fissures is primarily conservative, focusing on the prevention and treatment of constipation. This includes a high-residue diet, two liters of fluids, oily substances, sitz baths, and topical soothing agents. In rare cases, surgical treatment is necessary, consisting of incision of the internal anal sphincter or excision of the fissure. No progress in conservative treatment for 8 weeks prompts surgical treatment.

Recommendations after treatment

Drink 2 liters of fluid a day and eat foods rich in fiber to prevent the recurrence of anal fissures.

Anal fissure in pregnancy

An anal fissure is caused by recurrent constipation and can be treated with conservative methods such as sitz baths, prevention of constipation and topical soothing agents.

Anal fissure after childbirth

Postpartum anal fissure is a disease caused by tissue ischemia during the second stage of labour. Risk factors include prolonged labour, high birth weight, assisted delivery, and constipation. Treatment is the same as other cases, but surgery should be considered if conservative methods fail.



4th Professional Medical Student. Karachi Medical and Dental College.

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