An anal fissure is a tear in the anus causing a painful linear ulcer at the margin of the anus. Either extreme constipation or diarrhea, usually combined with nervous tension over a prolonged period of time, may produce anal abrasions, simple slit-like fissures, or acute ulcers at the anal verge. Lateral Partial Internal Sphincterotomy is the usual preferred technique.
An anal fissure (AY-nul FISH-er) is a tear in the anus causing a painful linear ulcer at the margin of the anus. An anal fissure, also known as fissure-in-ano, may cause itching, pain or bleeding. Fissures can extend upward into the lower rectal mucosa; or extend downward causing a swollen skin tab or tag to develop at the anal verge, also known as a sentinel pile.
Either extreme constipation or diarrhea, usually combined with nervous tension over a prolonged period of time, may produce anal abrasions, simple slit-like fissures, or acute ulcers at the anal verge. With constipation, this condition is usually caused by the passage of a hard dry stool that tears the anal lining upon defecation. With diarrhea, this condition is usually caused by an over use and over-wiping of an inflamed anal canal.
Because of an associated anal crypt infection, causing cryptitis, a fissure, an ulcer, or possibly even an abscess may occur at the superior aspect of the anal canal where it attaches to the lower rectal mucosa.
In some patients, the anal fissure doesn’t heal and becomes a painful sore that is constantly re-injured or torn with each bowel movement. The fissure usually develops a white fibrous base over time. Additionally, an external anal skin tag called a sentinel pile, and an enlarged papillae at the superior anal margin may develop.
A patient can pass shards of undigested material (i.e., stone ground corn chips, and sunflower seed shells) through the anus, tearing the anal skin, thus causing a fissure. Anal fissures also may be secondary to anorectal surgery, proctitis, tuberculosis, or cancer of the anus.
An anal fissure, a thin slit-like tear in the anal tissue, is likely to cause itching, pain, and bleeding during a bowel movement. View hemorrhoid gallery for a detailed photo.
A fissure produces pain at defecation and persists for hours. A small amount of bright red blood, which may or may not be mixed with stool, is common. A fissure produces pain disproportionate to its size. It is the third most painful common condition affecting the anus; the second most painful condition is an anal abscess, the first most painful condition is recovering from recent anal surgery.
Rarely, a spasm of the levator ani muscles, also known as proctalgia fugax, can be associated with chronic anal fissures. This condition may contribute to lack of healing of fissures… or may be caused by it.
Diagnosis can be made by inspection. Closer inspection will frequently reveal a tag or sentinel pile. After gentle separation of the skin of the anal verge, the ulcer usually posterior can be seen. Frequently the fibers of the internal anal sphincter muscle can be seen at the base of this punched-out ulcer. A well-lubricated finger with lidocaine ointment and a small caliber anoscope will help delineate the extent of the lesion. A colonoscope or sigmoidoscope exam might be useful to rule out abscesses, colitis, and other causes of rectal bleeding.
A fissure should be distinguished from an ulcer caused by Crohn’s disease, leukemia, or malignant tumors, because it is not shaggy, large or indolent. Fissures are seldom multiple. A biopsy can help to determine the diagnosis.