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Anal Fissure — Detailed Guide

Acute and chronic forms of the linear tear at the posterior midline of the anal canal and the current treatment protocol.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Anal Fissure — Detailed Guide?

Anal fissure is a linear mucosal tear in the squamoepithelial portion of the anal canal, usually in the posterior midline (6 o'clock position). Hypertonia of the internal anal sphincter is the main reason fissures become chronic; chronic fissures are accompanied by a sentinel pile (skin tag) and hypertrophic anal papilla.

Acute fissure is defined as one persisting less than 6 weeks; chronic fissure persists longer than 6 weeks. In chronic fissure, internal sphincter fibers may be visible at the floor of the fissure. Fissures in atypical locations or in the anterior midline (12 o'clock) suggest underlying pathologies such as Crohn's disease, tuberculosis or HIV.

Nitroglycerin ointment, calcium channel blockers and botulinum toxin injection are the cornerstones of medical treatment. In refractory cases, lateral internal sphincterotomy (LIS) is the surgical standard with a 95% healing rate.

Symptoms

Severe stabbing anal pain during defecation
Burning and cramping for hours after defecation
Bright red blood on the toilet bowl or paper
Worsening constipation due to fear of defecation (vicious cycle)
Skin tag at the anal verge in chronic fissure (sentinel pile)
Itching and irritation in the anal area

Risk Factors

Chronic constipation and hard stools
Acute diarrhea and inflammatory bowel disease
Anal sphincter hypertonia
Previous anorectal surgery
Perineal trauma during childbirth
Low-fiber diet

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe anal pain during or after defecation
  • Fresh bleeding on the toilet bowl
  • Fissure persisting longer than 6 weeks and unresponsive to medical therapy
  • Atypically located or multiple fissures (Crohn's, HIV evaluation)
  • Anal pain with fever and discharge (abscess should be ruled out)

Treatment Methods

01
First line: high-fiber diet, abundant fluid intake, laxatives and sitz bath
02
Topical nitroglycerin (0.2-0.4%): relaxes the internal sphincter; headache is the limiting side effect
03
Topical calcium channel blocker (diltiazem, nifedipine): similar effect to nitroglycerin with less headache
04
Botulinum toxin A injection: 20-30 units, 60-80% healing rate in chronic fissure
05
Lateral internal sphincterotomy (LIS): partial internal sphincter incision; 95% healing, 1-5% incontinence risk
06
Fissurectomy and flap repair: in cases unsuitable for LIS (sphincter insufficiency risk)

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.