An anal fissure is a tear in the lining of the anus or anal canal (the opening through which stool passes out of the body). The fissure can be painful and may bleed.
Anal fissures can occur in anyone at any age. The chance of having an anal fissure decreases as people get older. People who have had fissures in the past are more likely to have them in the future.
Anal fissures can be caused by trauma to the anus and anal canal. The trauma can be caused by one or more of the following:
Causes other than trauma include:
Anal fissures are also common in young infants and in women after childbirth.
Signs and symptoms of an anal fissure include:
Usually, your doctor can diagnose an anal fissure by visual inspection of the anus or by gentle exam with the tip of the finger.
The goal of anal fissure treatment is to lower the pressure on the anal canal by making stools soft, and to ease discomfort and bleeding. Conservative treatments are tried first and include one or more of the following:
These practices heal most fissures (80 to 90 percent) within several weeks to several months. However, when treatments fail and anal fissures persist or come back, other measures can be tried, including:
Before surgery is considered, your doctor will re-examine you and may conduct other tests to determine why other treatments have failed to heal the fissure.
A fissure may fail to heal because of scarring or muscle spasms of the internal anal sphincter muscle. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle to reduce pain and spasms and allow the fissure to heal. Cutting the muscle rarely results in the loss of ability to control bowel movements.
The surgery can usually be performed on an outpatient basis (the patient goes home the same day). Pain is relieved after a few days and complete healing takes place in a few weeks.
For fissures in infants:
For fissures in adults:
Last reviewed by a Cleveland Clinic medical professional on 02/22/2019.