An anal fissure or Fissure-in-ano is a tear or cut in the skin of the anal canal. The condition affects men and women equally and can occur at any age ( infants too ). Anal fissures are commonly found in the back part of your anus, in line with the cleft of your buttock.

A fissure which is present for less than 6 weeks is called an Acute fissure. That which is more than 6 weeks old is called a Chronic fissure. The Chronic fissure is usually hard to feel and may have a skin tag like growth called Sentinel Pile.


Causes of Fissure

Usually trauma to the anal canal causes a fissure.

  • Hard stools especially associated with constipation - The increased pressure exerted in an effort to pass the hard stools causes tearing of the delicate perianal skin.
  • Diarrhoea - The frequent forceful bowel movement causes tearing of the anal skin.
  • Iatrogenic - A tear may occur during insertion of a rectal thermometer, USG probe, endoscope, enema tube.
  • Childbirth
  • Anal sex - Commonly encountered in homosexuals.
  • Rare causes - Crohns disease, leukaemia, tuberculosis, sexually transmitted diseases, viral infections etc
  • Symptoms Of Fissure

  • Painful defecation - This pain while passing stools may be so severe that patients are frightened of a bowel movement and avoid one.
  • However this further causes constipation and hard stools, leading to a vicious cycle of trauma and hard stools. The pain during defecating may be severe, pricking or searing and the post defecation burning may last for a few hours.
  • Bleeding, sometimes seen as a streak of blood on stools or blood on the tissue.
  • Need to strain while passing stools - This is because the anal sphincter goes into a spasm.
  • Pruritus ani - Itching in the anal region.
  • Malodorous discharge
  • Sentinel pile - In long standing cases, a skin tag like growth can be felt at the edge of the fissure.
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