What's Causing My Anal Fissure?

Mild pain or discomfort following a bout of constipation or a particularly hard bowel movement is fairly common. But if you have chronic, ongoing pain — especially if it’s accompanied by bleeding — you might have a tiny cut called an anal fissure.

Anal fissures are experienced by many people, with about a quarter million new cases diagnosed every year in the United States. Fissures are often misattributed to painful hemorrhoids, which means many others could have fissures and not even know it.

At our practice in Coral Springs, Florida, Michael H. Tarlowe, MD, treats anal fissures using an individualized approach to ensure each patient receives the most appropriate care. If you have anal pain or bleeding, here’s how he can determine if your symptoms are caused by a fissure or another problem.

Why anal fissures happen

The anal canal is a short tube that connects the rectum to the anus. The anal canal is designed to be flexible, but like other muscular areas of the body, it has its limits. 

If the anal canal is stretched beyond those limits, tiny cuts can form in the tissue, making future bowel movements especially painful. In addition to pain, fissures are associated with other symptoms, like:

• Bleeding during a bowel movement
• Bleeding after a bowel movement
• Pain when sitting on a hard surface
• Itching or burning around your anus
• Formation of a skin tag or lump near the anus

Because anal fissures cause pain during bowel movements, many people avoid moving their bowels, leading to constipation, increased anal pressure, and worsening fissure symptoms.

Common causes of anal fissures

Anal fissures are most commonly caused by:

• Passing hard, dry stools
• Constipation
• Straining during bowel movements
• Chronic diarrhea
• Anal intercourse

They can also develop during pregnancy or delivery.

Less often, anal fisures are associated with other underlying medical problems, like:

• Inflammatory bowel disease (IBD)
• HIV infection
• Herpes
• Tuberculosis
• Syphilis
• Cancer

The key to treating anal fissures susccessfully is to have your symptoms evaluated to determine the underlying cause. Most anal fissures can be diagnosed with a simple visual exam of the area, but for deeper fissures, Dr. Tarlowe may use a thin, flexible tube called an anoscope to see inside the anal canal.

Treating anal fissures

Many anal fissures can be treated conservatively with options like:

• Drinking more water
• Eating plenty of high-fiber foods
• Taking stool softeners
• Using prescription ointments

If Dr. Tarlowe finds your sphincter muscles are very tight or subject to spasms, he might recommend Botox® injections to relax the muscle tissue, reducing painful symptoms while giving the fissure a chance to heal.

For chronic fissures or fissures that don’t heal despite these conserevative options, Dr. Tarlowe often performs a simple minimally invasive surgery called an anal sphincterotomy to create a tiny incision inside the anal canal. This incision helps the sphincter relax, giving the fissure time to heal. 

Don’t ignore anal pain or bleeding

A little bright red blood or discomfort after a hard bowel movement may be nothing to worry about, and usually it clears up pretty quickly. But if you have recurrent anal bleeding or pain or you notice any type of lump around your anus, it’s important to schedule an evaluation with Dr. Tarlowe so he can rule out serious problems and prescribe the best treatment for you.

To find out what’s causing your symptoms or to learn more about anal fissure treatment, book an appointment online or over the phone with Dr. Tarlowe today.