Suffering from severe illness like Fissure-in-ANO but don’t know much about it? Don’t worry. We are here to inform you of every little detail you need about such an illness. This article will lead you to all the essential parameters about Fissure-in-ANO, its symptoms, causes, treatments, surgery, and other things. So, let’s first start with the introduction.

Fissure-in-ANO Introduction

The fissure-In ANO is also known as anal fissure. It is a major source of perianal discomfort and frequently causes rectal bleeding. An anal fissure is a tiny break in the delicate, moist tissue which borders the anus (mucosa). When you release large or hard stools throughout a bowel motion, you may develop an anal fissure. These are known to cause discomfort and bleeding during bowel movements. You might even suffer spasms in the muscular ring at the end of the anus.

The fissure might sometimes be severe enough to reveal the muscular tissue beneath. Some medications, such as topical pain medications and stool softeners, can encourage healing and reduce discomfort.

Fissure-in-ANO is most frequent in infants but can occur at any age. Most anal fissures heal with modest therapies such as increased fiber consumption or sitz baths. Many patients with this illness may require medication or, in rare cases, fissure-in-ANO surgery. Patients often start late treatment for the disease because they are uncomfortable with the physical location of the disease.

It is typically not a dangerous ailment, and most individuals can cure it at home. However, persistent anal fissures, Fissure-in-ANO, or those that do not heal quickly are grounds for caution. In addition, the fissure might sometimes be severe enough to reveal the muscular tissue beneath. Some medications, such as topical pain medications and stool softeners, can encourage healing and reduce discomfort. Continue reading to discover more about the symptoms, causes, and treatments of anal fissures and how to avoid them in upcoming times.

Fissure-in-ANO Treatment

The majority of fissure-In ANO does not need substantial treatment. On the other hand, some natural remedies can help control and alleviate unpleasant symptoms. Moreover, you can cure an anal fissure by performing the following initiatives:

  • 1. Consuming extra drinks to keep hydrated and enhance digestion
  • 2. Making use of certain stool softeners
  • 3. Taking sitz bath to soothe anal muscles, alleviate discomfort, and enhance blood circulation to the anorectal region
  • 4. Eating additional fibrous meals and using fiber supplements
  • 5. To alleviate discomfort, use topical pain medications, including lidocaine, to the anus.

If the symptoms of anal fissures continue after attempting the above home remedies, see your clinician, who could prescribe additional treatments. The non-surgical solutions for treating the Fissure-in-ANO types are as under:

  • 1. Nitroglycerin (Rectiv) can be given externally to enhance blood circulation to the fissure, facilitating healing and softening the anal sphincter. If other conservative measures do not seem to be working, Nitroglycerin is often regarded as the best treatment.
  • 2. Pain alleviation could be aided by topical anesthetic medications like lidocaine hydrochloride (Xylocaine).
  • 3. Infusion of botulinum toxin type A or Botox injection to paralyze the muscles of the anal sphincter and ease spasms.
  • 4. Blood pressure drugs, including diltiazem (Cardizem) and nifedipine (Procardia), can help soothe the anal sphincter. These drugs, administered orally or administered topically, are used if the Nitroglycerin is ineffective or produces considerable negative effects.
  • 5. Other treatments that can heal the anal fissures appropriately may include fissure-in-ANO surgery.

Fissure-in-ANO Surgery

If you have a persistent fissure-in-ANO that has not responded to conventional therapies, or if the symptoms worsen, your doctor may suggest fissure-in-ANO surgery. Doctors typically conduct a treatment known as lateral internal sphincterotomy (LIS). It entails removing a tiny piece of the muscle of the anal sphincter to relieve spasms and discomfort and encourage recovery.

According to studies, surgery is far more beneficial than any medication therapy for persistent fissures. But unfortunately, there is little chance of persistent incontinence, which means you could no more be capable of regulating when you release stool.

Fissure-in-ANO Causes

What are the main fissure-in-ANO causes? You are probably curious about the causes now that you’ve learned enough about the treatments. The issue is often commonly caused by passing big or hard feces. Diarrhea or constipation regularly can potentially damage the skin surrounding your anus. Moreover, anal fissures do not always indicate a low-fiber diet or diarrhea. Poorly healed fissures or those situated in areas besides the midline and posterior of the anus might suggest an underlying disease.

Some of the other fissure-in-ANO causes include:

  • 1. Squeezing or straining during birthing or bowel motions
  • 2. Experiencing Crohn’s disease or another irritable bowel syndrome.
  • 3. Possessing anal sphincter muscles that are abnormally tight or spastic
  • 4. Reduced blood circulation to the anorectal region
  • 5. Participating in anal sex

The following are less prevalent fissure-in-ANO causes:

  • 1. Anal cancer
  • 2. HIV
  • 3. Tuberculosis
  • 4. Syphilis
  • 5. Herpes

Fissure-in-ANO Types

Talking about the Fissure-in-ANO types, the anal fissure is categorized into the following:

  • 1. Acute anal fissure: This fissure heals in six weeks. It is the most frequent form and generally occurs in a straight line with distinct edges.
  • 2. Chronic anal fissure: This fissure lasts longer than six weeks. The healing period for chronic anal fissures differs. Getting an anal fissure for months and years is common without therapy.

Chronic fissures are typically deeper than acute anal fissures and are frequently linked with an outer skin tag. Chronic fissures are normally curable. However, they frequently reoccur during the following therapy.

Other Fissure-in-ANO types are:

  • 1. Primary Anal Fissure: Occurs due to local trauma, including vaginal birth of a baby or constipation.
  • 2. Secondary Anal Fissure:  Occurs as a result of an underlying disorder, including Crohn’s disease, ulcerative colitis, or chlamydia.

Fissure-in-ANO Diagnosis

The medical practitioner will most likely inquire about the patient’s medical history and conduct a physical assessment, including a mild examination of the anal area. The break is frequently noticeable. This assessment is generally all that is required for Fissure-in-ANO diagnosis.

An acute anal fissure resembles a new tear like a paper cut. A chronic anal fissure is more prone to developing a deeper rip and internally or externally fleshy growths. If an anal fissure lasts longer than eight weeks, it is called chronic.

The position of the fissure provides information regarding its cause. For example, a fissure on the anal opening’s edge, instead of the front or rear, seems more likely to indicate some other ailment, like Crohn’s disease. If the doctor suspects an underlying disease, they may recommend another Fissure-in-ANO diagnosis, mentioned below:

  • 1. Anoscopy:  It involves a tubular device that the doctor inserts into the anus. The anascope assists the doctor in seeing the anus and rectum.
  • 2. Flexible Sigmoidoscopy: The doctor will introduce a flexible, thin tube with a tiny video recording device into the bottom of the colon. If you are under the age of 50 and thus have no potential risks for intestinal illnesses or colon cancer, you may be eligible for this Fissure-in-ANO diagnosis.
  • 3. Colonoscopy: The doctor will inject a flexible tube-like device into the rectum to evaluate the whole colon. This test can be conducted if you are over 50 years old or possess health risk factors for colon cancer, evidence of other illnesses, or signs like stomach discomfort or diarrhea.

Fissure-in-ANO Symptoms

An anal fissure may cause some of the symptoms listed:

  • 1. An obvious rip in the skin surrounding your anus
  • 2. Burning or itching in the anal region
  • 3. During bowel motions, there is a sharp discomfort in the anal region.
  • 4. A skin tag or tiny lump of skin beside the break
  • 5. Blood stains on toilet paper after cleansing

Other less prevalent anal fissure indications encompass the following:

  • 1. A sentinel pile is a skin tag that can form on the border of the anus underneath the fissure.
  • 2. When excrement is evacuated, the anus experiences spasms or a constricting sensation.
  • 3. Abscesses are painful boil-like puffiness around the anus that is packed with pus. It might result in a fistula, a passage from the anal canal to the exterior surface with foul-smelling mucous secretion.

Risk Factors

Risk factors that may influence the chances of having Fissure-in-ANO are as under:

  • 1. Constipation: Pressuring while bowel movements and releasing firm stools raise the chances of tearing.
  • 2. Anal intercourse.
  • 3. Childbirth: Anal fissures seem to be more prevalent in women after giving birth.
  • 4. Crohn’s disease:  This irritable bowel illness involves persistent digestive system inflammation, which might also render the anal canal wall more prone to tears.
  • 5. Age: Anal fissures can happen at any age. However, these are more prevalent in newborns and middle-aged people.

Fissure-in-ANO Anatomy

Acute Fissure-in-ANO types appear as a clear longitudinal break in the anoderm, occasionally accompanied by accompanying inflammation. Chronic fissures are frequently deeper and have visible internal anal sphincter (IAS) fibers at their base. It is typically linked with a thickened anal papilla on the proximal side and a sentinel pile or an irritable skin tag on the distal side.

The anal canal is divided into two types: surgical and anatomical. The surgical one is about 4 cm long and extends proximally from the anocutaneous line to the anorectal ring. The anatomical one is about 2 cm long and later stretches from the anal margin to the dentate line. The anal mucosa is the epithelium of the anal canal between the anal verge underneath and the pectinate line above. This region possesses a somatic feeling, hence why the fissures are unpleasant. The ATZ (anal transitional zone) is the area of the anal canal that extends for around 1-2 cm over the pectinate line. The columnar epithelium lines the anal canal over the ATZ.

The IAS is formed when the inner muscle fibers layer of the rectum and colons wells in its lowest part region across a span of 2.5-4 cm of the rectum. The IAS (internal anal sphincter) is an involuntary muscle that contracts continuously to avoid fecal and fatal incontinence. The external anal sphincter (EAS) surrounds the anal canal in a circular pipe. It joins the levator and puborectalis ani muscles proximally to create a single component.

The inferior rectal nerves and a perineal extension of the fourth sacral nerve supply it. This muscle is primarily contracted voluntarily. An anal fissure contains simply the epithelium, but when persistent, it covers the entire depth of the anal mucosa, exposing IAS fibers.

Preventive Measures

Although Fissure-in-ANO cannot always be avoided, you can lessen your chances of developing one by adopting the following preventive measures:

  • 1. Maintaining the anal area’s dryness.
  • 2. Gentle washing of the anal region with warm water and mild soap.
  • 3. Stay hydrated, consume fiber foods, and often exercise to prevent constipation.
  • 4. Treating diarrhea right away
  • 5. If a newborn has the disease, they should have their diapers changed regularly.

Clinical findings

Both fissure-in-ANO types might appear in patients. Individuals in the acute environment frequently complain of significant rectal discomfort, particularly with bowel movements characterized as strong and piercing, “like passing shards of glass or razor blades.” The discomfort subsides until the following bowel movement. For some, the discomfort is comparable to urolithiasis or delivery, while for others, the indications are moderate, and patients merely want comfort.

However, individuals with chronic anal fissures have persistent discomfort due to spasms and sphincter hypertrophy, with pain worse during defecation. The passage of bright red blood is a somewhat typical presenting sign. Patients are often constipated and defecated in a struggling manner. Feces that are painful promote an aversion to defecation, creating self-perpetuating and a vicious cycle. As a result, they tend to eat less to minimize the urge to pass feces.

Some people describe diarrhea bouts before the onset of symptoms. Other patients have complained of pruritus ani, even though this is not a usual clinical manifestation of a fissure.


Physical assessment in the left lateral view with the buttocks softly apart and the anal margin everted frequently reveals longitudinal dissociation of the anoderm at the bottom half of the anal canal. Because proctoscopic or digital rectal examination can cause severe discomfort, it must not be done if a fissure is predicted or visible in the conscious situation. When a secondary pathology is suspected and digital investigation and proctoscopy are required, they should be performed under regional, local, or general anesthesia.

Sometimes the Fissure-in-ANO diagnosis is uncertain, and the medical practitioner can’t see the fissure. Other times, the patient is at greater risk for colorectal cancer and has novel problems like bleeding per rectum. So, during such issues, an examination under anesthesia (EUA) with colonoscopy, anoscopy, and tissue sampling may be indicated. Similarly, depending on the results of the EUA, further research using endoanal ultrasonography, MRI, and CT scanning may be necessary.


Chronicity and physical appearance of Fissure-in-ANO are used to classify them. Acute fissures have symptoms for less than 6 weeks. They normally only affect the overlying mucosal layer, and there are no apparent IAS fibers at the fissure’s bottom. They usually have highly delineated, new mucosal margins, with granulation tissue at the bottom, and they recover independently.

The IAS hypertrophies become more efficient at maintaining the wound open, preventing spontaneous healing. Chronic anal fissures contain particular anatomical characteristics, including the previously stated exposed sphincter fibers at the base, sentinel pile, an anal papilla, and indurated edges.

Treatment options

Any treatment strategy must meet the following concerns:

  • 1. Helpful parameters
  • 2. Unpleasant stool passing 
  • 3. Pain control
  • 4. Atypical defecation patterns, such as excessive straining
  • 5. Reduced local ischemia and anal sphincter tone in hypertonic sphincter patients.

How to heal a fissure fast?

Anal fissures usually improve in a few weeks if patients take precautions to keep their stool loose, like increasing their fiber and hydration intake. In addition, bathing in warm water, particularly after bowel motions, can aid sphincter relaxation and healing.

Fissures with low anal pressures

The treatment of Fissure-in-ANO causes is mostly focused on reducing anal hypertonicity. Individuals experiencing anterior anal fissures had lower anal pressures, indicating a distinct etiology in forming these fissures. Postpartum individuals are more likely to have low-pressure anal fissures. These individuals are especially vulnerable to incontinence, with interventions to lower anal hypertonia. Therefore, it is extremely crucial to address low-pressure fissures more carefully.


To conclude, this article will depict all the necessary information about Fissure-in-ANO that everyone dealing with it should know. It includes causes, symptoms, treatments, and essential precautions to take. Hope, you find this article helpful. If you find any similar symptoms mentioned here, consult the best medical practitioner for help.

Frequently Asked Questions

What causes Fissure-in-ANO?

Inflammation to the wall of the anal canal or anus, the final segment of the large intestine, has been the most prevalent Fissure-in-ANO cause. Most occurrences occur in constipated patients when a very hard or big stool breaks the wall of the anal canal. Chronic diarrhea is another probable cause of anal fissures.

What is the most effective treatment for Fissure-in-ANO?

A doctor may prescribe a variety of medications to assist in alleviating your discomfort and enable your anal fissure to recover. Some of them are Nitroglycerin, pain killers, laxatives, topical anesthesia, and others.

Who is at risk for an anal fissure?

Individuals between the ages of 20 to 40 are the most prone to contracting them. However, they can appear at any age, although the risk normally decreases with age. Anal fissures are more common in those with particular medical disorders, like anal cancer.

How is anal fissure treated and documented?

Doctors typically conduct a treatment known as LIS (lateral internal sphincterotomy). It includes removing a tiny fragment of the anal sphincter muscle to ease spasms and discomfort and encourage recovery. According to research, fissure-in-ANO surgery is more beneficial than any medication therapy for persistent fissures.

What measures can be taken to prevent an anal fissure?

You might be able to avoid an anal fissure by avoiding diarrhea or constipation. Consume high-fiber meals, drink plenty of water, and work out frequently to avoid straining throughout bowel movements.

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