What are anal fissures?

    Anal fissures are small tears or splits in the skin at the anal opening. Although anal fissures are usually tiny, they lie in a very sensitive area, so they can be quite painful (especially during and after bowel movements). They can also cause bleeding with bowel movements. Because anal fissures are nothing other than small splits in the skin, however, they are not dangerous.

    What causes them?

    The usual reason anal fissures occur is lack of fiber in the diet. There are two circular or donut shaped "sphincterthat anal canal to control Over time, a diet low in fiber can cause the small inner anal sphincter muscle to become too tight, and the anal opening to narrow. Then, when a bowel movement occurs (especially a hard, constipated bowel movement), it can start a split in the skin at the anal opening.


    What can I do about anal fissures?

    Anal fissures usually respond to treatment at home. Sitz baths (sitting in warm water) may be all that you need. You can sit in the tub or buy a plastic sitz bath device that fits into a toilet, available at large pharmacies and medical supply stores. Take several 10-15 minute sitz baths daily. If you work outside the home, try taking a sitz bath in the morning, upon your return from work and before bedtime. Be sure to dry the rectal area thoroughly after each sitz bath.

    Stool softeners can help reduce pain during bowel movements. Special medicated creams may also be helpful. Once the fissure has healed, it is important to make lifestyle changes. Adding more fiber to your diet, drinking plenty of water, and getting regular exercise will help to prevent constipation, the cause of most anal fissures.


    How can I get more fiber in my diet?

    High-fiber foods include beans, broccoli, carrots, bran, whole grains and fresh fruits. Ask your doctor for patient handouts on dietary fiber and fiber content of foods. To avoid bloating and gas, add fiber-rich foods gradually over a period of several days. Drinking enough fluids (six to eight cups a day) will help you digest fiber and also help soften stools.

    If you don’t think you are getting enough fiber in your diet, you can also buy fiber supplements in the drug store (without a prescription). Some brand names are Metamucil, Citrucel, Konsyl and Perdiem Plain. Flavored and artificially sweetened varieties are available. The usual dose is 2 teaspoons or 2 packets in liquid once or twice a day.

    Home Treatments for Anal Fissures

    To avoid making anal fissures worse:

        After a bowel movement, blot the area gently with white toilet paper moistened with water. You can also use Baby Wipes or other premoistened towels (such as Tucks) for this purpose

        In the bath or shower, use only soaps without perfumes or dyes. Avoid rubbing the anal area. Gently pat dry with a soft, absorbent or cloth

    To relieve pain and itching:

        Apply ice several times a day for 10 minutes at a time. Follow this by placing a warm compress on the anal area for another 10 to 20 minutes

        Take a sitz bath once or twice a day. Sit in a tub or a pan of plain, warm water (at bath water temperature) for 15 to 20 minutes. You can buy a plastic sitz bath basin that fits into the toilet at larger pharmacies and medical supply stores. The sitz bath water keeps the area clean, decreases redness and swelling, and relaxes the muscles


    To prevent anal fissures from coming back:

        Add more fiber to your diet to prevent constipation. Focus on fruits, vegetables, and whole grains. Fiber supplements such as Citrucel and Metamucil can also add bulk to the diet. You can buy fiber supplements at a drug store without a prescription. They are not laxatives. They do not stimulate the bowel to move. They just help make your bowel movements soft and less irritating. Follow the label instructions for use. Be sure to drink plenty of water or other fluids when you increase the fiber in your diet

        Get more exercise. Moderate exercise - 30 minutes or more three or four times a week - helps keep your bowels functioning properly. Brisk walking, swimming, gardening, dancing, housework - any activity that gets you moving will do. Vary the kinds of exercise you do to keep it interesting

    This handout is developed from materials provided by Paul Shellito, MD, MGH Department of General Surgery.


    This document is intended to provide health related information so that you may be better informed.It is not a substitute for your care team’s medical advice and should not be relied upon for treatment for specific medical conditions.


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