The Most Common Causes of Anal Fissures

Every year, about 250,000 people in the United States are diagnosed with anal fissures, making them a relatively common problem among people of all ages. It may be difficult to know when to get treatment — and how to avoid developing a fissure in the first place.

Michael H Tarlowe, MD, is experienced in diagnosing anal fissures at his offices in New York City and White Plains, New York, providing custom treatment plans to help patients of all ages find relief from their symptoms. If you think you might have an anal fissure — or if you’d just like to know what symptoms to look for — we have the answers.

Anal fissures defined

The anus is a sphincter, which is like an elastic opening, that lets bowel movements pass from your body. An anal fissure is a small tear that develops near your anus as a result of excess stretching and pressure. Fissures form in the lining of the anus, most commonly toward the front or back. 

Anal fissures can affect anyone of any age, but they’re most common in pediatric patients and in people who are middle-aged and older. 

Other causes and risk factors include:

• Chronic constipation
• Inflammatory bowel disease
• Obesity
• STDs, like herpes, syphilis, or HIV
• Tuberculosis
• Thyroid disease

The most common symptom of an anal fissure is pain when having a bowel movement. Some level of pain and discomfort can persist for an hour or two afterward. Many people also experience bleeding. As the fissure heals or if the area is improperly cleaned, itching and burning can occur.

The causes of anal fissures

Hard bowel movements are the most common cause of anal fissures. While softer, normal stools can conform to the natural opening of the anus, hard, dry, compacted stools don’t have much “give.” As the stool is excreted, it exerts excess pressure on the anus, causing the sphincter to stretch beyond its normal limits. Stretching tears the membrane tissue, resulting in pain and bleeding.

Less commonly, an anal fissure can form as a result of diarrhea or loose bowels. In this instance, repeated bowel movements can wind up irritating the tissue and causing small tears. Fissures may also form as a result of vaginal childbirth. Regardless of the cause, the primary symptoms — pain and bleeding — are the same.

Chronic fissures

When we tear our skin, we help it heal faster by protecting it. But with an anal fissure, we don’t really have that option. The next time we have a bowel movement, the fissure will stretch again, making it a lot harder to heal. At the same time, the sphincter muscle tends to become irritated in the area of the tear, resulting in muscle spasms that stretch the tear farther.

Although it can take a while, most anal fissures will heal over time, typically in a few weeks. Sometimes, though, that repeated cycle of stretching, irritation, and spasms results in a chronic condition, where anal fissures occur repeatedly or last for eight weeks or more. In fact, some statistics say about 40% of patients with anal fissures go on to develop a chronic problem.

Treating anal fissures

Most anal fissures heal over time, but sometimes they need a little help. Increasing your dietary fiber and drinking more water can help keep your stools softer, so they don’t stretch the anal sphincter beyond its normal limits. An over-the-counter stool softener may help, too. 

Dr. Tarlowe might prescribe calcium channel blockers to improve blood flow to the area, so healing occurs more quickly, or he might advise BotoxⓇ injections to reduce muscle spasms in and around the sphincter.

When these steps don’t resolve chronic anal fissures, Dr. Tarlowe may recommend a surgical procedure called a sphincterotomy. In this procedure, a tiny incision is made in the sphincter muscle, relieving pressure on the sphincter so it can heal.

Get those symptoms checked

Anal fissures are a common cause of bloody bowel movements, but they’re not the only cause. Colorectal cancer also causes blood in the stool, and so can hemorrhoids, infections, and other underlying problems. 

If you’re having bloody bowel movements on a regular basis or you’re having pain when you move your bowels, it’s important to have your symptoms evaluated right away to make sure you get the best treatment as soon as possible. To schedule a visit or to learn more about anal fissure treatments, call our office or use our online booking form.