Anal fissure

An anal fissure is a tear in the anal mucosa. Hard bowel movements and chronic constipation are the main causes of anal fissures. A distinction is made between acute and chronic anal fissures. In the case of chronic anal fissures, scar tissue and folds of skin, known as skin tags, have already formed in the area of the fissure.

Anal fissures occur predominantly in the back of the anus (in the direction of the coccyx). Chronic constipation, hard bowel movements and excessive straining during bowel movements are the main reasons why an anal fissure occurs. Pre-existing haemorrhoids or an inflammation of the mucosa can also contribute to the occurrence of tears in the mucosa. If an anal fissure exists for more than 6 weeks or when there is already scar tissue or folds of skin (skin tags) have formed in the area of the mucosa, this is known as a chronic anal fissure.

Typical symptoms of an acute anal fissure are stabbing pains during a bowel movement. The pain can continue for some time after the bowel movement.  It sometimes causes minor bleeding; the blood in question is bright red. Those affected often hold their bowel movements back due to the impending pain, which leads to a vicious circle with hardening of the stool and constipation. If the course becomes chronic, there will also be itching, a feeling of dampness in the anus and repeated traces of blood on the toilet paper.

Bleeding during bowel movements or bloody diarrhoea in the stool should always be checked by a doctor. An anal fissure is usually visible to the naked eye. If there another suspected cause for the bleeding, a colonoscopy is carried out.

An acute anal fissure is usually treated conservatively. The patient’s bowel movements must firstly be regulated. The stool is softened and the constipation is remedied with fibre-rich food, increased fluid intake and mild laxatives. Wound-healing creams are applied to support the healing of the mucosa tear.

Surgery is usually the only solution for chronic anal fissures Depending on the situation, different surgical methods are used. Find out more in the Anal surgery section.