ANAL FISSURE

General Information

DEFINITION--A laceration, tear or crack in the lining of the anus.

BODY PARTS INVOLVED--Anus.

SEX OR AGE MOST AFFECTED--All ages, but most common in infants, young children and adults over 60. This affects more women than men.

SIGNS & SYMPTOMS

• Sharp pain with passage of a hard or bulky stool. The pain may last up to an hour and returns with the next bowel movement.
• Pain when sitting on a hard surface.
• Streaks of blood on the toilet paper, underwear or diaper.
• Itching around the rectum.
• Children may refuse to have a bowel movement.

CAUSES--The exact cause is unknown, but the symptoms usually occur after the stretching of the anus from a large, hard stool.

RISK INCREASES WITH

• Constipation.
• Multiple pregnancies.
• Leukemia, Crohn's disease, immunodeficiency disorders.

HOW TO PREVENT

> Avoid constipation by:

Drinking at least 8 glasses of water daily. Eating a diet high in fiber. Using stool softeners or other laxatives, if needed.

• Don't strain at stool.
• Avoid anal intercourse.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Examination of the anus and rectum with an anoscope or sigmoidoscope to rule out other causes of anal or rectal bleeding.

APPROPRIATE HEALTH CARE

• Home care.
• Doctor's treatment.
• Surgery may be necessary to remove the fissure or to alter the muscle that contracts and prevents normal healing (see Anal-Fissure Removal and Anal Sphincterectomy in Surgery section).

POSSIBLE COMPLICATIONS--Permanent scarring that prevents normal bowel movements.

PROBABLE OUTCOME--Most adults recover in 4 to 6 weeks with treatment, making surgery unnecessary. Most infants and young children recover after the stool is softened.

How To Treat

GENERAL MEASURES--

• The following should be done to prevent constipation in children until the fissure heals: For infants: Before bedtime, fill a rubber ear syringe with plain mineral oil. Gently insert the tip and squeeze the mineral oil into the infant's rectum. Repeat the next morning. If no bowel movement occurs, repeat at noon. After the bowel movement, clean the anus gently with cotton and water. For older children: Gently squeeze 4 ounces of mineral oil into the rectum. You may use a sanitary napkin to catch oil that seeps out in the night.
• To relieve muscle spasms and pain around the anus, apply a warm towel to the area.
• Sitz baths also relieve pain. Use 8 inches of very warm water 2 or 3 times a day for 10 to 20 minutes. Be careful not to burn a young child.

MEDICATION--

• For minor pain, you may use non-prescription drugs, such as acetaminophen or topical anesthetics.
• Zinc oxide ointment or petroleum jelly applied to the anal opening may help prevent the burning sensation.
• Bulk stool softeners will help to avoid the pain occurring with bowel movements.

ACTIVITY--No restrictions. Physical activity reduces the likelihood of constipation.

DIET--Encourage a high-fiber diet and extra fluids to prevent constipation.

Call Your Doctor If

You or your child have symptoms of an anal fissure--especially pain--that persists despite treatment.