Diseases & Conditions

Anal Ulcer - Anal Fissure


Overview, Causes, & Risk Factors

An anal fissure is a tear in the internal lining of the anus. This area is called the anal mucosa. This break in the anal lining often reopens during bowel movements. The result is bright red blood and intense pain.

What is going on in the body?

An anal fissure is a tear in the bowel lining. It causes painful, bloody bowel movements. It is often confused with hemorrhoids, which are painful swellings at the anus caused by enlarged veins. A fissure can be acute or chronic. The chronic condition is often associated with a buildup of tissue at the external end of the tear. This is called a sentinel pile and may be noticed by an affected person. The internal end may also have a buildup of tissue that an affected person can rarely see.

When a fissure is present, the mucosa of the anus opens each time it is stretched to allow for a bowel movement. This continual opening prevents healing. It can also leave scar tissue. Most chronic fissures are in the center of the back of the anus.

The anal sphincter muscles need to relax for a person to have a bowel movement. A person with a fissure may have muscles that are too tight. This makes bowel movements painful.

What are the causes and risks of the condition?

Anal fissures are usually related to abnormal bowel movements. Constipation or frequent stools can cause straining and worsen the problem. Injury to the anal area can also damage the anal mucosa. Pregnancy or difficult delivery is often a cause of this trauma. There are also several medical conditions that can cause anal fissures, including:

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  • tuberculosis
  • Crohn's disease
  • malignant tumors
  • Venereal warts, which are sexually transmitted warts caused by a virus, can look like anal fissures and may have similar symptoms.


    Symptoms & Signs

    What are the signs and symptoms of the condition?

    The most common symptoms are pain during and after a bowel movement. Often the person will notice bright red blood on the toilet tissue or blood dripping into the toilet after a bowel movement. Because bowel movements are painful, many people complain of constipation.


    Diagnosis & Tests

    How is the condition diagnosed?

    Anal fissures are diagnosed by physical exam and an anoscopy. An anoscopy allows the healthcare professional to inspect the anal canal using a special device that opens the anus.


    Prevention & Expectations

    What can be done to prevent the condition?

    Usually, anal fissures can be prevented by maintaining regularly formed bowel movements. High fiber diets and stool softeners, such as docusate, are often beneficial.

    What are the long-term effects of the condition?

    Untreated anal fissures can lead to anal fistulas, which are abnormal connections between the anus and another organ, usually a different part of the bowel. They can also cause anal stenosis, or an abnormal narrowing of the anal canal.

    What are the risks to others?

    Most of the time, anal fissures are not contagious. Rare exceptions occur if the condition is caused by an infection.


    Treatment & Monitoring

    What are the treatments for the condition?

    Treatment of an anal fissure depends on how long the fissure has been present. Acute or relatively new fissures can usually be managed with a bulk-forming laxative, such as psyllium or senna, and a local anesthetic cream.

    These measures may help chronic fissures, but more intensive treatment is usually necessary. Nitroglycerin cream may be useful. However, a surgical treatment called a lateral internal sphincterotomy may be needed. This procedure divides the most superficial of the two anal muscles and corrects any problems. It also allows easier passage of stool through the anal canal. The operation can be done using a local or regional anesthetic.

    What are the side effects of the treatments?

    Once the condition is corrected, there are few side effects to anal fissures. However, a person is at risk of developing another fissure if he or she does not make diet or lifestyle changes. Any surgery involves the risks of anesthesia, infection, and bleeding.

    What happens after treatment for the condition?

    An individual needs to eat a high fiber diets, maintain regular eating habits, and drink plenty of fluids each day.


    Attribution

    Author:Michael Peetz, MD
    Date Written:
    Editor:Slon, Stephanie, BA
    Edit Date:03/24/00
    Reviewer:Adam Brochert, MD
    Date Reviewed:08/07/01