Anal Fissure: Symptoms, What It Looks Like, and Why It Is Dangerous

Sharp pain during defecation and bright red blood on toilet paper are a typical picture of an anal fissure. In frequency it is second only to hemorrhoids. We explain what this tear is, what it looks like, where it comes from, and how it is distinguished from other problems.

What an anal fissure is

An anal fissure is a linear or elliptical longitudinal tear of the mucous membrane of the anal canal. Simply put: a small wound that arises spontaneously and causes sharp pain during and after defecation, sometimes with scant admixtures of blood in the stool. The anus is the opening at the end of the large intestine through which stool passes.

Fissures can be acute — usually after an episode of constipation or diarrhea — and chronic, which exist for more than a month. In a chronic fissure the edges are dense and raised, the exposed sphincter muscle is visible, and a sentinel tag and hypertrophied anal fringe appear nearby. By location, posterior, anterior, and "mirror" fissures are distinguished; most often the tear runs along the midline, along the posterior semicircle. The disease occurs at any age but is more characteristic of young people, especially women of young and middle age.

Main symptoms of an anal fissure

The main sign is pain. It is sharp and cutting and occurs during defecation.

• sharp cutting pain during and after defecation;
• burning after a bowel movement, which may last several hours;
• sphincter spasm, sometimes lasting several hours or constantly;
• bright red blood in the toilet, on the paper, or on the surface of the stool;
• itching in the anal area.

Bleeding is usually minor — traces on underwear and paper. With an acute fissure it can be severe, even spurting, which is life-threatening and can lead to anemia. With a chronic fissure, pain drags on for a long time and intensifies not only after a bowel movement but also in a forced position; fear of defecation, insomnia, irritability, and attempts to cope with laxatives and enemas appear.

What a fissure looks like: outside, inside, and without blood

The doctor examines the skin around the anus and, if necessary, prescribes anoscopy. A posterior fissure is located on the posterior wall of the anal canal; anterior and "mirror" fissures also occur. An acute one looks like a linear defect of the mucosa, a chronic one like a wound with dense calloused edges.

Any symptoms require a doctor's examination. Blood may be scant and appear episodically. The main symptom is pain during and after defecation; if there is no pain but there is blood or itching, the cause is determined by the doctor.

Why fissures appear in the anus

The cause is not always obvious. Common variants: constipation and the passage of hard dry stool, frequent diarrhea, friction from toilet paper, pregnancy and vaginal childbirth with tears during pushing, lifting heavy objects, sphincter spasm, injuries from external objects — enemas, instruments, adult toys — anal sex, inflammatory bowel diseases (Crohn's disease, ulcerative colitis), sexually transmitted infections such as syphilis and herpes.

In men, the weak spot is the posterior wall of the canal, where the sphincter muscles converge. In women, it is the anterior wall, where the vulva, vagina, and perineal center converge. Therefore, in women the fissure is more often anterior, in men posterior.

Anal fissure and hemorrhoids: what the difference is

Pain and blood from the anus are not only about a fissure. Hemorrhoids are more common than a fissure: pain and blood from the anus also occur with hemorrhoids, abscesses, fistulas, and tumors. Common signs of problems with the anus are bleeding, discharge, itching, pain, and swelling. The cause is established by the doctor after examination.

How the diagnosis is made and when to see a doctor

Diagnosis begins with a discussion of symptoms and medical history. The doctor examines the skin around the anus, then may perform a digital rectal examination — inserting a lubricated gloved finger into the lower rectum to feel for indurations. Next is anoscopy, an examination of the anal canal. If the picture is unclear, there is suspicion of a serious cause, or the examination causes pain and spasm, the patient is referred to a specialist for examination under general anesthesia.

See a doctor if symptoms worsen or do not resolve within a week. Acute fissures heal in 40–60% of people once stool normalizes. If it does not heal, the tear becomes chronic: in response to pain the tone of the internal sphincter increases, the fissure hides behind the folds, does not clean itself, becomes inflamed — and the cycle closes.

An anal fissure by itself is not a reason to call an ambulance. 103 or 112 — if there is heavy bleeding from the anus, including spurting: with an acute fissure it can be severe, life-threatening, and may lead to anemia.

The text is for reference: it does not replace a doctor's consultation and examination.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer