How to stop anal fissure bleeding?

In case of rectal bleeding due to anal fissures or fissure in ano, the patient may prevent the bleeding by the following anal fissure self-care measures: The patient should wipe the anal area very softly and gently instead of rubbing roughly. Patting is better than rubbing the anal region. Take the warm sitz bath or anal fissure hip bath to relieve the condition. Using physician-prescribed ointments and medicines to reduce the bleeding symptoms. Taking a healthy diet which is rich in fibre. Taking plenty of fluids to pass the stool without effort. Avoiding strain when passing the stool.

How to treat anal fissure?

The treatment for anal fissure or fissure in ano is based on the severity of the condition. The treatment is of two types: non-operative/non-surgical treatment and surgical treatment; the type of treatment depends on the patient’s condition. Firstly, the patient will be suggested conservative management and lifestyle modifications, including diet, sitz bath, and some anal fissure medicines. If conservative management fails, the patient is advised for pharmacological treatment, including topical analgesics, muscarinic agents, botulinum toxin, nitrates, and vasodilators. Patients with severe and chronic fissures are suggested for the surgeries, which include internal sphincterotomy and laser surgeries.

Is anal fissure dangerous?

Usually, anal fissures are not dangerous. They will resolve by lifestyle modifications and pharmacological treatment initially or, in severe cases by surgeries. However, if they are left untreated, they could develop complications which tend to be serious. The complications of anal fissures are fistula formation, bleeding, and infections.

What does an anal fissure look like?

An anal fissure looks like a tear or cracks with a sore (ulcer) on the lining of the anal canal near the anus. These are of two types acute and chronic. Acute anal fissures last less than six weeks, whereas chronic anal fissures last more than six weeks.

How to poop with an anal fissure?

The patient must pass the stools softly using a stool softener for anal fissure. In addition, the patient must consider the following preventive measures to poop effortlessly. Patients should not hold the stool for longer times, which results in the formation of harder stools. Taking sitz or tub baths a few times daily Avoiding straining and longer duration in toilets Taking fibre rich diet and staying hydrated by drinking plenty of water results in passing the stool very comfortably

Which doctor treats anal fissure?

Initially, the patient might be confirmed with anal fissures by the general physician, and then the general physician recommends the patient to go to the consultant surgeon/ surgical gastroenterologist based on the patient’s condition.

How to diagnose anal fissure?

Usually, anal fissures will be diagnosed by the gastro surgeon/interventional radiologist. The physical and digital rectal examinations initially diagnosed the anal fissures. If the anal fissures are not visible with the naked eye, then the consultant anal fissure doctor goes for Anoscopy and colonoscopy for keen visualisation.

Which is the best ointment for anal fissure?

Some studies have shown that topical ointments or anal fissure creams containing calcium channel blockers are most effective than nitrates in treating fissures due to their fewer side effects.

What to eat in anal fissure?

The patient with anal fissures is recommended to eat anal fissure dietary fiber. Some fibre-rich foods include cereals, fruits, vegetables, oats and wholegrain bread.

How to get relief from anal fissure?

The patient may get anal fissure pain relief by taking a warm sitz bath or tub bath. It is a type of therapy where the patient sits in warm or cold water to minimise the itching and pain symptoms by getting a soothing effect in the anal and genital areas.

Anal fissure - Fissure in ano: Symptoms, Causes, Types, Complications

Pace Hospitals

Anal fissure meaning

An anal fissure is also called fissure in ano, anorectal fissure, it is a laceration or tear (open sore) formed in the bottom section of the anal canal near the anus and rectal lining. These are usually common due to the inflammation of blood vessels. The skin tear in the anal region is superficial and distal to the dentate line and is classified into acute anal fissures and chronic anal fissures. Anal fissures and hemorrhoids are common, and both conditions tend to pass the stools much harder.

anal fissure picture | fissure in ano images | chronic anal fissure skin tag | anorectal fissure | anal fissure real images

Incidence of anal fissures (fissure in ano)

Anal fissures (anorectal fissure) are commonly seen in infants and middle-aged individuals. For the past 30 years, there have been no evidence-based studies regarding the exact incidence or prevalence of anal fissures; this may be due to misattribution to haemorrhoid symptoms.

However, the incidence is more common in females than males; anal fissures are more prevalent in patients with comorbidities such as chronic constipation, inflammatory bowel disease, hypothyroidism, obesity, and solid tumours without metastasis.

Types of anal fissure (fissure in ano)

Anal fissures (anorectal fissure) are classified into two types based on the duration of time, they are:

Acute anal fissures
Chronic anal fissures

Acute anal fissures: Anal fissures lasting less than six weeks are categorised into acute anal fissures. In terms of acute anal fissures, they heal quickly with simple management without the need for traditional procedure. They usually resolve within six weeks with mild to moderate symptoms.

Chronic anal fissures: Anal fissures lasting more than six weeks are categorised into chronic anal fissures. The symptoms of chronic anal fissures worsen gradually. Only a few patients may heal the fissures without intervention, and most may not heal. Less than 10% of patients heal with traditional procedures; the rest need further management to resolve the problem. Anal spasms, severe pain, and bleeding on defecation are the typical symptoms usually seen in chronic anal fissures.

signs and symptoms for anal fissure

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causes of anal fissure

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Anal fissure symptoms

The symptoms of anal fissure (fissure in ano) include:

Sharp anal pain is seen during the stool passage, followed by burning pain for a few hours.
Bleeding on defecation of stools.
An anal tear or cut is especially seen in chronic fissures.
Small anal bump or anal fissure and skin tag near the anus.
Anal spasm.

Anal fissure causes

The causes for anal fissures (fissure in ano) are as follows:

Chronic constipation
Chronic diarrhoea
Inflammatory bowel disease
Passage of hard stools
Anal injury
Childbearing or vaginal delivery
Eating low fibre diet
Inflammation of anus
Scratching due to pinworm Infection
Excessive wiping of the anus after stool passage
Rectal cancer

Anal fissure risk factors

Usually, the risk factors resemble the causes, but the risk factors differentiate with causes in terms of direct linkage. The risk factors are not the exact cause of the condition, but they are the factors that may lead to the condition.

The risk factors of anal fissures (anorectal fissure) are as follows:

Constipation: It causes hard stools to pass, which may lead to an anal tear
Diarrhoea: The anal skin is very sensitive, so diarrhoea can cause fissures by cracking/tearing the skin.
Inflammatory bowel diseases (ulcerative colitis and crohn's disease): Peri anal diseases (piles, fissures) are the common complications of inflammatory diseases due to severe symptomatic conditions such as constipation and persistent diarrhoea.
Sexually transmitted diseases (HIV, syphilis etc.): Sexually transmitted infections (STIs) cause ulcerations, lesions and bleeding in the anorectal regions, possibly leading to fissures.
Anal cancer: Usually, the symptoms of anal cancer are the same as fissures causing lumps, pain, and bleeding, so people with colon or anal cancer may develop fissures, but people with fissures won't develop anal cancer.
Tuberculosis (TB): TB is one of the inflammatory conditions in the anorectal region. It may cause symptoms such as itching, bleeding and discharge, which in turn causes anal fissure or fistula.
Anal intercourse: Anal intercourse or inserting any objects into the anus may lead to an anal tear or crack due to the increased pressure near the anal sphincter.
Pregnancy: Pregnant women may experience constipation due to hormonal changes and pressure by the foetus.
Childbirth: Due to heavy contractions and pressure during labour, the women may experience anal fissures.

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Complications of anal fissure (fissure in ano)

Complications of anal fissure (anorectal fissure) include:

Infection: Chronic fissure may lead to the abscess formation
Bleeding: Anal fissure hurts and may cause bleeding during stool passage
Pain: The exposure of the external sphincter muscle under a tear leads to spasms and pain.
Incontinence: In chronic anal fissure patients, the function of the internal sphincter is altered due to hypertonia and may cause a minor degree of incontinence.
Formation of fistula (serious complication): In severe conditions, fistula may arise from chronic anal fissures.
Anal stenosis: In anal fissure condition, it may develop hypertrophy in some conditions and lead to fibrous polyp’s formation. This could lead to anal stenosis and loss of compliance.

complications of anal fissure | anal fissures complication | chief complaints of anal fissure

Anal fissure diagnosis

The diagnosis of anal fissure includes:

Physical examination
Digital rectal examination (DRE)
Proctoscopy (medical procedure to examine rectum and anus)
Anoscopy (medical procedure to examine the lining of the anus)
Sigmoidoscopy (procedure to examine sigmoid colon) & Colonoscopy (medical procedure to examine the colon) for colon examination
CT scan (computed tomography) and MRI scan (magnetic resonance imaging) will be done if the naked eye does not see the fissures.

Prognosis

Patients with acute anal fissures are lower in risk and resolved by conservative treatment. Still, in a few cases, they may develop into chronic anal fissures requiring surgical procedures and pharmacological management. The anal fissure cure will be seen within 3 to 4 weeks in patients who underwent surgical procedures.

Anal fissure treatment

The treatment for anal fissures includes:

Lifestyle modifications (diet and habits)
Analgesics for pain
Laxatives
Botulinum injection and anal fissure ointments containing nitrates
Anaesthetics
Surgeries:
Open lateral internal sphincterotomy
Closed lateral internal sphincterotomy
Fissurectomy
Laser surgery (laser sphincterotomy with fissurectomy)

Anal fissure prevention

Patients may prevent anal fissures by the following conditions:

Anal fissure diet:

Taking fibre rich diet
Staying hydrated by drinking plenty of water
Avoid too much alcohol and caffeine
Taking fibre supplements such as ispaghula, methylcellulose, bran, or sterculia helps to prevent constipation

Medications:

Using OTC (over-to-counter) anal fissure medications such as stool softeners and anal fissure pain relievers to reduce the disease progression
Applying the lubricants or petroleum jelly to the anus

Habits:

Doing exercises regularly
Patients should only hold the stool for a short time, which may lead to the formation of hard stools.
Taking sitz or tub baths for few times daily
Avoiding straining in toilets
Maintaining healthy weight

Anal fissure vs fistula | Difference between anal fissure and anal fistula

An anal fissure (fissure in ano) is a tear that occurs in the outer layer of the anal canal, whereas an anal fistula is an abnormal passage or tunnel that usually arises from the inside of the anal canal to the skin outside the anus.

Characteristics	Anal fissure	Anal fistula
Symptoms	Pain on defecation and bleeding	Pain and discharge with a foul smell
Causes	Constipation, inflammatory bowel diseases, childbirth etc	Inflammatory bowel problems, problems with childbirth etc.
Risk factors	Constipation, diarrhoea, anal injuries, inflammatory bowel diseases etc	Having Crohn’s disease, childbirth, constipation etc.
Treatment	Usage of analgesics, antibiotics for anal fissure, laxatives, corticosteroids and treatment with surgical procedures.	Usage of antibiotics, anti-inflammatory agents, laxatives, vasodilators, and some surgical treatments.
Prevention	Taking fibre rich diet and making habitual changes such as having sitz bath, maintaining a healthy weight etc	Taking fibre rich diet and making some habitual changes, avoiding straining and maintaining dryness in the anal region etc

✅ For appointment

Call Us at 04048486868 +914048486868

Whatsapp Us

FAQs (frequently asked questions on anal fissure / fissure in ano)

How to stop anal fissure bleeding?
In case of rectal bleeding due to anal fissures or fissure in ano, the patient may prevent the bleeding by the following anal fissure self-care measures:
- The patient should wipe the anal area very softly and gently instead of rubbing roughly.
- Patting is better than rubbing the anal region.
- Take the warm sitz bath or anal fissure hip bath to relieve the condition.
- Using physician-prescribed ointments and medicines to reduce the bleeding symptoms.
- Taking a healthy diet which is rich in fibre.
- Taking plenty of fluids to pass the stool without effort.
- Avoiding strain when passing the stool.
How to treat anal fissure?

The treatment for anal fissure or fissure in ano is based on the severity of the condition. The treatment is of two types: non-operative/non-surgical treatment and surgical treatment; the type of treatment depends on the patient’s condition.

Firstly, the patient will be suggested conservative management and lifestyle modifications, including diet, sitz bath, and some anal fissure medicines. If conservative management fails, the patient is advised for pharmacological treatment, including topical analgesics, muscarinic agents, botulinum toxin, nitrates, and vasodilators.

Patients with severe and chronic fissures are suggested for the surgeries, which include internal sphincterotomy and laser surgeries.
Is anal fissure dangerous?

Usually, anal fissures are not dangerous. They will resolve by lifestyle modifications and pharmacological treatment initially or, in severe cases by surgeries.

However, if they are left untreated, they could develop complications which tend to be serious. The complications of anal fissures are fistula formation, bleeding, and infections.
What does an anal fissure look like?

An anal fissure looks like a tear or cracks with a sore (ulcer) on the lining of the anal canal near the anus. These are of two types acute and chronic. Acute anal fissures last less than six weeks, whereas chronic anal fissures last more than six weeks.
How to poop with an anal fissure?
The patient must pass the stools softly using a stool softener for anal fissure. In addition, the patient must consider the following preventive measures to poop effortlessly.
- Patients should not hold the stool for longer times, which results in the formation of harder stools.
- Taking sitz or tub baths a few times daily
- Avoiding straining and longer duration in toilets
- Taking fibre rich diet and staying hydrated by drinking plenty of water results in passing the stool very comfortably
Which doctor treats anal fissure?

Initially, the patient might be confirmed with anal fissures by the general physician, and then the general physician recommends the patient to go to the consultant surgeon/surgical gastroenterologist based on the patient’s condition.
How to diagnose anal fissure?

Usually, anal fissures will be diagnosed by the gastro surgeon/interventional radiologist. The physical and digital rectal examinations initially diagnosed the anal fissures. If the anal fissures are not visible with the naked eye, then the consultant anal fissure doctor goes for Anoscopy and colonoscopy for keen visualisation.
Which is the best ointment for anal fissure?

Some studies have shown that topical ointments or anal fissure creams containing calcium channel blockers are most effective than nitrates in treating fissures due to their fewer side effects.
What to eat in anal fissure?

The patient with anal fissures is recommended to eat anal fissure dietary fiber. Some fibre-rich foods include cereals, fruits, vegetables, oats and wholegrain bread.
How to get relief from anal fissure?

The patient may get anal fissure pain relief by taking a warm sitz bath or tub bath. It is a type of therapy where the patient sits in warm or cold water to minimise the itching and pain symptoms by getting a soothing effect in the anal and genital areas.