Definition

     An anal fissure is a small split or tear in the anal mucosa that may cause painful bowel movements and bleeding. There may be blood on the outside of the stool or on the toilet tissue following a bowel movement.

Causes

• Constipation

• Straining

• High internal sphincter tone

• Anal sex

Signs and symptoms

     The main signs and symptoms of an anal fissure include:

• Pain or burning during bowel movements that eases until the next bowel movement

• Bright red blood on the outside of the stool or on toilet paper or wipes after a bowel movement

• Itching or irritation around the anus

Screening and Diagnosis

• Inspection of the rectum

• Physical exam of the rectal mucosa

• Anoscope

• Flexible Sigmoidoscopy

Treatment

• Stool softeners

• Dietary adjustment (addition of bulk -- substances that absorb water while in the intestinal tract)

• Cleansing more gently

• Petroleum jelly

• Sitz bath

• Anesthetic ointment, if pain interferes with normal bowel movement

• Topical muscle relaxants

Prevention

     You may be able to prevent an anal fissure by taking measures to prevent constipation. Eat high-fiber foods, drink fluids and exercise regularly to keep from having to strain during bowel movements.