An anal fissure is a small tear in the lining of the anal canal, just inside the opening. It is associated with spasm of the lower portion of internal anal sphincter muscle (the 'automatic door closer') abnormally raising the pressure in the lower portion of the anal canal. This increased pressure reduces the blood flow to the base of the fissure, prohibiting healing. Failure of the muscle to relax normally during bowel movements increases the trauma to fissure itself.
Anal fissures are typically painful, with sufferers often describing the pain as 'sharp' and the passing of a bowel movement like 'passing glass'. Sometimes the pain is experienced mainly after the bowel movement has passed (often described as 'throbbing') and can last for hours. Rarely, an anal fissure may be painless. Anal fissures often cause rectal bleeding.
An acute anal fissure (one that is new) may respond to simple measures such as fiber supplementation and increased water intake to soften the stool. When these measures fail and the fissure becomes more chronic, specific medical therapy is available to help relax the internal sphincter, allowing the fissure to heal in about 2/3 of patients. If this medical therapy fails, there is a simple outpatient procedure that is nearly always successful in healing the fissure and preventing its recurrence. In addition to being painful, an untreated fissure may eventually lead to other complications.
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