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Faeces (poo) is temporarily stored in the rectum and expelled from the body via the anus. An anal fissure is a tear or split in the lining of the anus (anal mucosa). The symptoms and signs include pain when passing a bowel motion and bright red blood from the anus.

The problem is common in children younger than one year, and affects around eight out of 10 babies. A person’s susceptibility to anal fissures tends to decline with age. Common causes in adults include constipation and trauma to the anus (such as a difficult childbirth).

Around half of cases heal by themselves with proper self-care and avoidance of constipation.

However, healing can be a problem if the pressure of passing bowel motions constantly reopens the fissure.

Treatment options include surgery

The symptoms and signs of an anal fissure may include: blood smears on the toilet paper. The anus permits bowel continence, which is voluntary control over the passage of bowel motions. Waste is massaged down the length of the large intestine by waves of muscular contractions (peristalsis).

Once the excess water is removed, the waste is temporarily stored in the rectum. The rectum joins to the anus, which is a short tube containing a muscular ring (sphincter) that can be opened at will to allow the expulsion of faeces (poo). The membranous lining of the anus is called the anal mucosa.

An anal fissure is a tear in the anal mucosa.

Some of the causes include: cancer of the rectum

Anal fissures aren’t associated with more serious diseases, such as bowel cancer, although cancer of the anus may mimic an anal fissure.

Some of the possible complications of an anal fissure include:

  • the tear fails to heal. Over time
  • this can cause extensive scar tissue at the site of the fissure (sentinel pile). – abnormal ‘tunnels’ join the anal canal to surrounding organs
  • usually other parts of the bowel

– the anal canal becomes abnormally narrowed either due to spasm of the anal sphincter or contraction of the resultant scar tissue. An anal fissure is diagnosed using a number of tests including: inspection of the anus and rectum with a slender instrument (anoscope). Medical treatment for an anal fissure may include: nitroglycerin creams or Botox injections to relax the associated muscle spasm.

Severe anal fissures need to be surgically corrected

The fissure and associated scar tissue is removed

Sometimes, a thin slice of muscle from the anal sphincter is also removed, as this helps the wound to better heal. (Cutting and suturing this muscle doesn’t interfere with the patient’s sphincter control.) The operation, called a lateral internal sphincterotomy, can be performed under local anaesthetic.

Around nine out of 10 people will never experience another anal fissure.

Be guided by your health care professional, but general suggestions include: Apply petroleum jelly to the anus.

See your chemist for advice on ointments specific for anal pain

Take regular sitz (salt bath) baths, which involves sitting in a shallow bath of warm water for around 20 minutes.

Use baby wipes instead of toilet paper

Shower or bathe after every bowel motion

Drink six to eight glasses of water every day. Many cases of anal fissures are caused by chronic constipation. Suggestions include: Eat a high-fibre diet.

Drink plenty of water to help soften stools

Consider using a fibre supplement (such as Metamucil). Make sure to wipe gently after going to the toilet. Symptoms of anal fissure anal pain pain when passing a motion and for some time afterwards bright red blood from the anus blood on the surface of stools Role of the anus Causes of anal fissure chronic constipation passing a dry, hard stool rough or excessive wiping of the anus after passing a motion diarrhoea inflammation of the anus and rectum Crohn’s disease scratching (as a reaction to pinworm infection, for example) anal injury pregnancy childbirth Complications of anal fissure Chronic anal fissure Anal fistulas Anal stenosis Diagnosis of anal fissure physical examination Treatment for anal fissure pain-relieving medication laxatives anaesthetic creams Surgery for anal fissures Self-help for anal fissures Prevention of anal fissures Where to get help Your GP (doctor) Pharmacist.

Key Points

  • symptoms and signs include pain when passing a bowel motion and bright red blood from the anus
  • problem is common in children younger than one year, and affects around eight out of 10 babies
  • Common causes in adults include constipation and trauma to the anus (such as a difficult childbirth)
  • Treatment options include surgery
  • symptoms and signs of an anal fissure may include: blood smears on the toilet paper