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Anal Fissure: Symptoms, Causes, Treatment And Cost

Last Updated: Jun 07, 2023

What is an Anal fissure?

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Anal fissure can be described as a cut or tear on the skin, in or around the anal area. It can cause extreme pain accompanied by red blood spots during stool.

Fissures are known to affect people of all ages, however, it predominantly remains common among infants or middle-aged people.

Fissures can often be taken off at home and do not necessarily pose any health hazard.

Stool softeners or some pain relief medications can help in mild cases. If nothing works, then your doctor might ask for surgery.

What are the signs and Symptoms of Fissure

When a patient suffers from anal fissures, he or she may show one or more of the following symptoms:

  • A visible tear around the anal
  • A lump of skin next to the tear
  • Burning and itching around the tear
  • Bowel movements become difficult and harder to pass
  • Streaks of blood spots in the stool or on the toilet paper
  • Foul-smelling discharge
  • Constipated stomach

The symptoms of anal fissure in males and anal fissure symptoms in females are very similar. These symptoms are not the same for all and can differ. To understand your condition better, you should see a doctor once you experience any early symptoms of anal fissure.

What causes anal fissures?

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If the patient suffers from chronic constipation or frequently experiences diarrhea, he/she is more likely to suffer from anal fissure. Passing a hard stool or putting too much strain may also cause the skin around the anus to tear.

However, these causes of fissures are caused by either constipation or a low-fiber diet which causes hard stool. Not all patients have fissures for these reasons. If your fissure is recurring, does not heal within 6-8 weeks, or is located in a region other than the mid-posterior area of the anus, it could mean that you have an underlying disease, the side-effect of which is fissures.

Other causes of anal fissure may include

  • Straining during a bowel movement or normal delivery in childbirth
  • Crohn’s disease, ulcerative colitis, or other inflammatory bowel diseases can also cause anal fissures.
  • When anal sphincter muscles become tight or spastic
  • Inserting foreign objects inside the anus can tear the skin around the anus which leads to anal fissure
  • Performing anal sex
  • Decreased blood flow in the anorectal area

In some rare cases, anal fissures causes can also be due to:

  • Tuberculosis
  • Syphilis
  • Anal cancer
  • Being HIV positive
  • Suffering from herpes

How can you prevent Anal Fissures?

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Anal fissures, as discussed previously, can arise due to multiple factors. They cannot always be prevented, however, certain preventive measures can be taken to lower the risk of acute/chronic anal fissures:

  • Always try to keep the anal area dry. After passing the stool and cleaning the area with water, make sure you also dry the area with a clean towel.
  • The skin around the anus region is quite soft and tender. Wash the area with a bar of mild soap and water regularly to keep away bacteria and germs.
  • Drinking plenty of fluids like water and fruit juices, eating a fibre-rich diet and exercising daily can effectively lower the chances of recurring anal fissures.
  • If you are suffering from diarrhoea, consult with your doctor to put you on diarrhoea medications.
  • Prolonged symptoms of diarrhoea can aggravate anal fissure symptoms.
  • If your child is suffering from anal fissure, changing the diapers at regular intervals is important.
  • Keep the baby’s anal area clean and dry to avoid itching and irritation.

Do’s in Anal Fissures

  • Having a healthy lifestyle is important. A nutritious, well-balanced diet, regular workout and including fruits and vegetables in your diet are a must. Drinking at least 3-4 litres of water a day helps a lot.
  • If you have severe, long-lasting bleeding in the area, seek medical help.
  • Warm water baths can often help with easing the pain of anal fissures.
  • Avoid consuming alcohol, red meat or any food items that may increase the chances of community.

Don’ts in Anal Fissures

  • Stool softeners help in lowering the chances of having hard stool which further aggravates anal fissures, but do not consume softeners because you feel better. These medications should only be consumed under the prescription of your doctor.
  • Until the doctor gives you a thumbs up, do not consume any medication/over-the-counter pills while your anal fissure symptoms are active.
  • Carefully notice your symptoms. If you see your condition is not turning for the better, contact your doctor immediately.
  • While wiping your bottom, don’t rush and wipe as this will agitate the area.
  • Avoid pushing your stool too hard.
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Diagnosis and Tests

If you notice the symptoms of anal fissure, you will need to consult a doctor.

How is an anal fissure diagnosed?

Before performing any diagnosis, your healthcare provider will ask you about any medical history. A physical exam may be performed, which includes a general and thorough inspection of the anal region. An anal fissure has a single or multiple cuts in the region that is noticeably visible, so this physical examination is all that the doctor requires to confirm before proceeding with diagnostic tests.

What tests are done for fissures?

If your doctor thinks that you have underlying diseases like Crohn’s after seeing the nature of your fissure, he may ask you to undergo the following testing methods:

  • Anoscopy: This test involves a small tube that is inserted inside the anus, giving the doctor a good view of the rectum and anal region.
  • Colonoscopy: In this test, a flexible tube is inserted inside your rectum to allow the doctor a view of the entire colon area. This test is usually administered when the patient is over 50 years old and has a risk of colon cancer.
  • Flexible sigmoidoscopy: This test is done if the patient is younger than 50 and has no risk associated with colon cancer. A long, flexible, and thin tube with video at the end is inserted inside the rectum to let the doctor capture a clear image of the insides.

What are the possible complications of Fissure?

Several complications associated with anal fissures left untreated have been seen over the years. Some of them are as follows:

  • Reduced life quality due to constant reminders of pain and discomfort
  • Due to the pain, bowel movements become toilsome. Many people avoid frequent stool passing due to this.
  • After treatment, there may be possibilities of recurrence
  • Clotting in the area and gas formation

What are the home remedies for Fissures?

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In some cases, anal fissures are capable of recovering on their own. However, with the following fissure treatment at home remedies symptoms of anal fissures can subside effectively:

  • Including dietary fibre will help stool passing easier, thus causing less pain during bowel movements. Good examples of high-fibre food items are pumpkin seeds, soybeans, legumes, sprouts and beans.
  • Drinking more water is always a great anal fissure treatment at home. You can also include food items in your diet that have high water content, like broccoli, cabbage, cucumber, tomatoes, watermelons and lettuce.
  • Sitz baths have been proven to ease any pain associated with anal fissures. Available at drugstores, sitz baths are small tubs. They are to be filled with warm water and to be sat on so that the affected area is submerged for about 10-15 minutes. Emollients like Epsom salt can be added as well.

What to eat in Anal Fissure?

Here are some food items to be incorporated into your diet if you are suffering from anal fissures:

  • Papaya: Both ripe and raw papayas help with better digestion. Papayas are also known to be extremely hydrating, containing about 88% water content. Getting enough water in your system can also rule out dehydration and hard stool, associated with constipation.
  • Lemons: Bursting with vitamin C, lemons are a great addition to your diet in you have anal fissures. One lemon has around 21% of the daily recommended value (DMV) of vitamin C for an adult. It is an antioxidant that helps in skin health and collagen synthesis. Squeezing a lemon or two in a glass of water not only helps you get this water-soluble vitamin in the body but also adds to your daily hydration.
  • Bananas: A great source of fibre, bananas help with passing smoother and softer stools. Make sure your bananas are ripe enough before consumption, as unripe bananas have a high amylase-resistant starch level, known to aggravate constipation further.
  • Turmeric: Recognized for its anti-inflammatory and antioxidant properties for centuries, turmeric has curcumin helps in wound-healing and skin disorders.
  • Probiotic-rich foods: Food items like curd helps with clearing the digestive tract and smoother bowel passing. The bacterial culture is curd to feed the gut bacteria. You can also consume other probiotic-rich foods like miso, kimchi and sauerkraut.
  • Legumes: Chickpeas, lentils and beans are high in zinc content. Zinc deficiency is one of the major causes why there is a tissue injuries like anal fissures in the body. Zinc is also a tremendous source of fibre, known to soften and regulate smoother bowel movements.

What not to eat in Fissure?

Some food items should be strictly avoided when suffering from anal fissure symptoms. They are as follows:

  • Spicy foods: Foods with high chilly powder should be avoided. They aggravate the stomach intestines and make stool passing a tedious job.
  • Fried foods: It is easy to consume fried snacks, but difficult to digest as they have almost zero fibre content. They are typically made of all-purpose flour which is very hard for your stomach to digest.
  • Red meat: Red meat is hard for the stomach to digest, so try to limit or cut down red meat consumption until your symptoms of fissure have lessened.
  • Salty foods: Food made with excessive salt can make you dehydrated. This, in turn, makes stool passing hard and is not good for patients with anal fissures.
  • Alcohol: Excessive consumption or regular alcohol intake while suffering from anal fissures is not good as it dehydrates the body.
  • Processed and packaged foods: They have no fibre content and do not add bulk to the stool. Consuming fresh foods and cutting down on processed or frozen foods is a good option for anal fissures.
  • Caffeinated beverages: Drinks like strong tea, milk or black coffee has a tendency to make your nerves active, but they are not good for the stomach, especially for people with anal fissures.

When is the right time to visit the doctor?

Schedule a visit with your doctor if the symptoms are not showing any signs of lessening after home remedies are done meticulously. You should seek medical help immediately if:

  • You are feeling lightheaded, dizzy or faint accompanied by bright red blood from the rectal passage,
  • Fevers, foul-smelling discharge, chills along with excruciating pain in the affected area

If you're older than 40, consult with your doctor in case of rectal bleeding. With an early diagnosis, serious diseases like colon cancer can be ruled out.

Anal Fissure Treatment (Surgical )

Two types of surgical procedures can be followed

Lateral internal sphincterotomy

In a sphincterotomy, the sphincter muscles in your bottom are cut to release the tension, which lets the fissure heal. This procedure can be done in two ways. In an open sphincterotomy, the surgeon makes a small cut in your skin so that the sphincter muscle can be seen and the cut is left open to be healed. In a closed sphincterotomy, your surgeon passes a blade under your skin to reach and cut the muscle. This is an extremely effective type of surgery for anal fissures.

Anal advancement flaps

This procedure involves the surgeon taking a healthy piece of skin and replacing it on the damaged skin of the fissure area. If the patient is likely to suffer from incontinence post-op, the surgeon may advise this course of surgery.

Pristyn Care has a highly experienced, skilled and well-trained team for anal fissure surgery. The team follows a USFDA-approved procedure and takes minimal time to complete the surgery. High-quality types of equipment are used in the surgical procedure to prevent any chances of recurrence in future.

Which are the best medicines for Fissure?

If painkillers and laxatives do not help, your doctor may prescribe you the following medications for anal fissure treatment:

  • Glyceryl trinitrate: If your symptoms of anal fissure do not show any signs of getting better, a medication called glyceryl trinitrate (GTN) may be prescribed. It is an ointment applied on the anal canal, typically twice a week. GTN works by expanding the blood vessels around the anal region, thus allowing more blood flow in the area and relieving the area of pain, itching and swelling.
  • Topical anaesthetics: These are prescribed when the pain in the anal area is excruciating. Anaesthetics help numb the pain, especially before you go for bowel passage. Topical medications are rubbed directly on the affected area. Although they do not necessarily heal the area but have an impact on easing the pain. Lidocaine, in either ointment or gel form, is a highly-prescribed topical cream for anal fissures.
  • Calcium channel blockers: Topical calcium channel blockers help with easing anal fissure symptoms. They work by relaxing the sphincter muscle and increasing blood supply to the fissure. A good example of calcium channel blockers is diltiazem.
  • Botulinum toxin injections: This relatively new treatment for anal fissures have been rendered safe if used in small and prescribed doses. If no other medication works, this toxin injection is used to paralyse your sphincter muscle and does not allow it to spasm, thus easing any sign of pain and relaxing the fissure.

Just like the home remedies, medicines too can only subside the symptoms of fissure in most of the cases. Surgery, on the other hand, is the perfect solution to get rid of fissures instantly.

Anal Fissure Treatment (Non Surgical)

  • Local ointments: After your doctor has done a physical examination of your fissure, he will prescribe local ointments in the form of topical medicines or jellies. They will help with the swelling by easing the pain and inflammation.
  • Oral Medicines for anal fissures: Doctors may also suggest anti-inflammatory drugs for easing the pain. Since they can be in tablet, capsule or syrup form, taking them at the right time in the prescribed dose is important. Oral laxatives may also be given to soften the stools.
  • Sitz bath: They are quite common in easing the pain. Sitz baths are small tubs available at your nearest chemist. Fill the sitz bath with warm water and sit on it, so that the affected area is submerged in the water. Sit in this position for about 5-10 minutes and repeat 2-3 times a day to get maximum comfort from the pain.

When do fissure need surgery/Is Fissure surgery urgent?

Typically, an anal fissure operation is carried out if the fissure persists for more than 8 weeks. When an anal fissure has not been healing for more than 8 weeks or has recurred time and again, the doctor will advise you to get surgery done. With small incisions and minimal risk, anal fissure surgeries can be conducted. Doctors recommended surgery to avoid any complications in the future.

What is the procedure of Fissure surgery/How fissure surgery is done?

Two types of surgical procedures can be followed:

Lateral internal sphincterotomy

In a sphincterotomy, the sphincter muscles in your bottom are cut to release the tension, which lets the fissure heal. This procedure can be done in two ways. In an open sphincterotomy, the surgeon makes a small cut in your skin so that the sphincter muscle can be seen and the cut is left open to be healed. In a closed sphincterotomy, your surgeon passes a blade under your skin to reach and cut the muscle. This is an extremely effective type of surgery for anal fissures.

Anal advancement flaps

This procedure involves the surgeon taking a healthy piece of skin and replacing it on the damaged skin of the fissure area. If the patient is likely to suffer from incontinence post-op, the surgeon may advise this course of surgery.

Pristyn Care has a highly experienced, skilled and well-trained team for anal fissure surgery. The team follows a USFDA-approved procedure and takes minimal time to complete the surgery. High-quality types of equipment are used in the surgical procedure to prevent any chances of recurrence in future.

How painful is Anal Fissure surgery?

Fissure surgery (or sphincterotomy, the most common type of surgery) is less painful than having to deal with the constant pain of the fissure itself. The surgery involves having mild pain during and a few weeks after the operation, but it slowly reduces any kind of pain that has been associated with the pre-op fissure skin itself.

How long does it take to recover from a Fissure?

Anal fissures often heal within a few weeks if you take correct home remedies or medications to keep your stool soft, such as increasing your intake of fibre and fluids. However, on average, 2 to 4 weeks is adequate time for your fissure to fully heal under normal circumstances. If your fissure is chronic or has arisen due to underlying diseases such as Crohn’s, then the time to heal may be much longer.

What is the price of Fissure treatments in India?

In India, the average fees for a general fissure surgery like sphincterotomy range from Rs. 18,000 to Rs. 50,000 with a success rate of around 92%. If you are wondering how to find all this information, you can directly come to Pristyn Care and find out every single detail about fissure surgery cost and expenses. Pristyn Care also has some of the finest surgeons in the country to provide anal fissure surgeries at a very affordable price.

Are the results of the Fissure treatment permanent?

After the fissure has healed, it can recur easily. It is common for a fully healed fissure to recur after a strained and hard bowel movement or another injury. Even when the pain and bleeding associated with fissures have subsided, it is very important to continue to have a good lifestyle and a balanced diet.

What are the Fissure post-treatment guidelines?

After surgery, certain precautions need to be maintained for a speedy recovery:

  1. Any form of strenuous activity should be avoided for at least 1-week post-op.
  2. Sitz baths should be taken thrice a day. For the first few days post-op, a sitz bath should also be taken after every bowel movement.
  3. Eating fibre-rich food to avoid constipation.
  4. Fresh fruits and vegetables to be included in the diet.
  5. Drinking 7-8 glasses of water daily.
  6. Use the OTC medications and ointments as and when prescribed by the doctor.
  7. Follow-ups post-op should be done on time. Usually, the first follow-up with the doctor is after 3 weeks post-op.

What are the side effects of Fissure treatments?

Some medications may cause nausea, lightheadedness, dizziness, fever and vomiting. Even after post-op, you may experience these symptoms. If the symptoms are extreme, consult your doctor immediately.

Signs a fissure is healing

  • The pain you used to experience when walking or sitting for stool is slowly lessening
  • There is little or no blood on your stool
  • The discomfort or itching in the area is also seemingly less
  • You are being able to sit down at once without being reminded of the pain

Preparing for your appointment

What can you do?

  • Be at the doctor’s office before the time allotted to you.
  • Wear loose and easily accessible clothing so that the doctor can proceed with the medical test with ease.
  • Bring someone with you to the doctor’s chamber to remember things the doctor says that you may forget
  • Keep a mental list of all your symptoms to tell the doctor promptly upon being asked

Some basic questions to ask your doctor include:

  • What diet should I stick to?
  • Are my conditions temporary or chronic?
  • Do I have an underlying disease that is causing my symptoms?
  • Are there any physical or dietary restrictions that I need to follow?
  • Do I need to undergo tests?
  • Is my condition serious? Do I need surgery?

Questions a doctor can ask to a fissure patient

  • When did you start experiencing any symptoms?
  • Are your symptoms severe?
  • Have your symptoms shown any sign of improvement?
  • How long ago did you experience your first symptom?
  • Do you have any underlying diseases?

What can you do in the meantime?

While you wait to hear from your doctor about the necessary course of action to be taken, help yourself with bringing a change in your dietary habits and drinking plenty of water. You can also include certain cardio or some form of physical activity in your daily life.

Fissure - Outlook / Prognosis

Conclusively, fissures may not be life-threatening but are a cause of embarrassment and discomfort. With proper medication and lifestyle changes, anal fissures can be treatable at home. When medications are not showing any effect, your doctor may opt for surgical methods. The moment you sense the first sign of fissure, you should try some home remedies. Hence, getting the correct opinion of the doctor is of utmost importance and highly recommended.

Frequently Asked Questions (FAQs)

What is the main cause of fissure?

Constipation, strained bowel movements, passing hard and large stools at once and chronic diarrhoea are some of the main causes of anal fissures.

How do you heal a fissure?

By increasing fibre intake, drinking lots of fluids and following home remedies meticulously, anal fissures can easily be healed unless they are chronic.

What is the best cream for fissures?

Lidocaine cream, Reactive (nitroglycerin) and Nifedipine cream are some of the top-prescribed creams and ointments for anal fissures.

How do I know if I have a haemorrhoid or a fissure?

The main difference to be spotted is that haemorrhoids tend to show painful symptoms all day, while fissure symptoms become noticeably painful during bowel movements.

What is the fastest way to heal a fissure?

Sitz bath thrice a day has proven to be effective in easing pain and fissure symptoms quite fast.

Is Vaseline good for fissures?

Petroleum jellies like vaseline can soothe the area and ease the pain, but no studies have shown the effectiveness of vaseline in healing fissures completely.

Why is my fissure not healing?

The reason could be that the sphincter muscle has become extremely tensed that blow flow to the lining has effectively reduced, thus causing the fissure to not heal.

How do you sit with a fissure?

Sitting can be quite painful if you have fissures. It is recommended that you do not sit on hard surfaces like wooden chairs or stone benches. Sit on cushions. While defecating, don’t sit on your toilet seat for too long as it might trigger bleeding. Taking laxatives will ensure that your bowel movements are more regular.

Does itching mean the fissure is healing?

Itching does not necessarily indicate healing of the fissure. When your fissure heals and then reopens (usually during defecation), it may trigger itching.

Which antibiotic is best for fissures?

Self-medication can be dangerous for your health, especially if you take antibiotics without consulting your doctor. Let your doctor prescribe antibiotics and the dosage depends on the condition of the fissure.

How to cure a fissure permanently without surgery?

Including fruits, fresh vegetables and other fibre-rich foods good for reducing constipation, taking medications on time may help reduce fissures without surgery.

How can you numb fissure pain?

By applying topical medications like lidocaine, any pain associated with fissure symptoms can be numbed for some time. After the medication wears off, the pain will slowly come back. The medication needs to be applied at regular intervals for the pain to stay numb.

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Written ByDr. Pankaj Verma ACLS,POST GRADUATE COURSE IN RHEUMATOLOGY,Fellowship in Diabetes,MBBS,Post Graduate Course In Rheumatology,MD - Medicine,Masters in Psychotherapy and CounsellingInternal Medicine
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Reviewed ByDr. Bhupindera Jaswant SinghMD - Consultant PhysicianGeneral Physician
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