Anal Fissures

Anal fissures are cracks or tears in the skin around your anus. The crack in the skin exposes the muscle underneath, causing burning and sharp pain when you have a bowel movement. The pain can last for hours after the bowel movement and can be severe. These cracks are usually caused by the passage of a hard stool but also can be caused by persistent diarrhea.

Some people get fissures once in awhile and others can become chronic, lasting for years. The pain of a fissure may cause people to avoid having a bowel movement leading to chronic constipation. People are often embarrassed to see a doctor because of the location of the pain or they are afraid they will cause more pain. Fissures leave a "tag" of skin at the anal opening that people often mistake for a hemorrhoid.

Treatment

The fissure won't heal without good blood supply, not unlike any other wound on the body. Unfortunately, the spasm caused by the exposed muscle keeps blood away from the area, making it unlikely to heal.

• Hot baths. Taking hot baths, with the water up as high as your tub allows, and relaxing the anal muscles will allow blood to flow into the area. Most people have trouble knowing how to relax the muscle without contracting it first. So, while you are in the tub, contract the muscle you use to stop having a bowel movement or to urinate. Then concentrate on relaxing that muscle. Do this every five minutes while you are in the tub. Take a bath three times a day and usually the fissure will heal within four weeks.
• Fiber. If you have a hard bowel movement during this time, you can re-crack the skin. So it is very important to increase the amount of fiber in your diet. You can do this by eating more raw fruits and vegetables and by taking additional fiber like the products listed below. The soluble fiber found in the prepared fiber supplements will make your bowel movements soft and allow the fissure to heal.
• Fluids. You also must drink adequate amounts of fluid, up to eight glasses a day.
• Surgery. If your fissure does not heal in four weeks or you have had your fissure for a long time you may need surgery. The surgeon will cut the fissure open in a procedure called a sphincterotomy. This will hurt initially but the fissure will be gone and probably won't come back. This procedure is done on an outpatient basis. Small numbers of people who have had this operation may leak gas or stool.