Anal Fissure

What it is

An anal fissure is a small tear in the skin lining the anal canal, usually in the posterior midline, causing sharp pain during bowel movements, often described as a cut, along with a small amount of bright red bleeding. The pain makes the sphincter contract even more, which reduces local blood flow and hinders healing, creating a cycle that turns an acute fissure into a chronic one. It is common after constipation, diarrhea or childbirth. At Femi Saúde, the coloproctology team confirms the diagnosis with a careful exam, without causing unnecessary pain, and manages treatment in stages, from clinical measures and ointments to botulinum toxin and, when necessary, sphincterotomy, always with attention to preserving continence.

Most common symptoms

• Sharp, cutting pain during bowel movements
• Pain that lasts for hours after a bowel movement
• Bright red blood on toilet paper
• Fear of having a bowel movement, worsening constipation
• Itching or burning in the anus
• A small sentinel skin tag at the anal edge

Causes and risk factors

• Hard stools and straining during bowel movements
• Frequent diarrhea
• Vaginal childbirth
• Increased tone of the internal anal sphincter
• Inflammatory bowel disease

How it is diagnosed

The diagnosis is based on the typical history of pain during bowel movements with bright red bleeding, and on a careful inspection of the anal area, which usually reveals the fissure when the buttocks are gently parted. In the acute phase, the digital rectal exam and anoscopy may be postponed to avoid causing pain, and performed once the patient is more comfortable. Fissures in an atypical position, multiple fissures, or ones that don't heal lead the coloproctologist to investigate other causes, such as Crohn's disease, infections or lesions, with further tests when necessary.

How we treat it at Femi Saúde

Acute fissures usually heal with softer stools (fiber, water and, if needed, mild laxatives), warm sitz baths and ointments that relax the sphincter and relieve pain. For chronic fissures, the coloproctology team at Femi Saúde may recommend a botulinum toxin injection into the sphincter, given in the office, and, when healing still doesn't occur, lateral internal sphincterotomy, a brief surgery with same-day discharge. The choice takes into account how long the fissure has lasted, the response to previous treatments, and sphincter function, especially after childbirth.

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