Anal Fissure

Anal fissure is a very unpleasant painful disease of the rectum. It is a crack of the wall of the anal canal, usually located in its front part. The solution is usually surgical.


The rupture of the mucosa and deeper structures of the rectum usually occurs due to chronic constipation with solid and bulky stool. The stool injures the rectal wall during its movement through the anal canal. Of course, we should not forget that the injury of rectal mucosa may be related to various sexual practices such as anal sex or inserting any foreign objects into the rectum.


Anal fissure cause very unpleasant anal pain, which gets worse during defecation. The rupture may bleed resulting in red blood in stool and on the toilet paper (similar to hemorrhoids). Besides the pain, the patient often suffers from itching of the rectum. Anal fissure may not heal and it can be easily infected by intestinal bacteria. In such case, there occurs a non-healing painful ulcer with mucous or suppurative discharge.


Anal fissure



Patient with above-described troubles should be examined by a doctor, in ideal case by a proctologist. The fissure can be seen by the naked eye and the doctor may also perform the digital rectal examination to rule out other diseases such as the colorectal cancer. However, the digital rectal exam must be performed very gently as it can be very painful in a patient with anal fissure.


The best prevention is adequate hydration and sufficient fiber intake to prevent the constipation and injury of the rectum by passing hard stool. Proper hygiene after bowel movements is also important including washing the anus by water. Regarding any sexual activities involving the anus – when it is a “must do” for you, at least do it cautiously :-).


Initially, it is possible to try to heal the anal fissure conservatively. The patient should keep strict hygienic standards and wash after every bowel movement. Regular sitz baths and use of local anti-inflammatory drugs in form of suppositories are also advised. When the conservative therapy fails, it is necessary to perform a surgical intervention. The operation is performed in general anesthesia as it would be too painful. A special dilating device is inserted into the rectum and the anal canal is dilated. It sound paradoxically as further dilation may seem to worse the condition. However, the fissure gets stretched, its edges are irritated and this situation triggers local healing reaction resulting in gradual disappearance of the fissure.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources