Navigating anal fissures: Symptoms, causes, and treatment

Written by: Mr Andrew Brian Williams
Edited by: Kate Forristal

Anal fissures are a common yet often distressing condition that affects many individuals. If you are experiencing pain during bowel movements or noticing blood on your toilet paper, you might be dealing with an anal fissure. In his latest online article, Mr Andrew Brian Williams aims to provide you with a clear understanding of what anal fissures are, their symptoms, causes, and treatment options.

What are anal fissures?

An anal fissure is a small tear or crack in the lining of the anus, which is the opening at the end of your digestive tract where stool leaves the body. These fissures can cause significant discomfort and bleeding during and after bowel movements. While they can affect people of all ages, they are particularly common in infants and young children, as well as adults who experience frequent constipation or diarrhoea.


Symptoms of anal fissures

The symptoms of anal fissures can be quite distinct and include:

  • Sharp pain during bowel movements 
  • Noticeable red blood on the stool or toilet paper 
  • An obvious tear in the skin around the anus 
  • A small lump or skin tag near the tear
  • Itching or irritation around the anus

If you experience any of these symptoms, it is essential to consult with a healthcare professional for a proper diagnosis and treatment plan.


Causes of anal fissures 

Various factors can lead to the development of anal fissures. These include:

  • Constipation: Hard, dry stools can cause tears in the anal lining as they pass through.


  • Diarrhoea: Frequent loose or watery stools can irritate and damage the anal lining.


  • Straining: Straining during bowel movements can put excessive pressure on the anus, leading to fissures.


  • Inflammatory conditions: Conditions such as Crohn's disease can cause chronic inflammation of the intestinal tract, making the anal lining more susceptible to tears.


  • Childbirth: The strain and pressure during childbirth can lead to the formation of anal fissures in some women.



Treatment options for anal fissures

The treatment for anal fissures often starts with non-invasive methods. These can include:

Dietary changes: Increasing fibre intake through fruits, vegetables, and whole grains can help soften stools and reduce constipation.


Hydration: Drinking plenty of water can keep stools soft and easier to pass.


Sitz baths: Soaking the anal area in warm water several times a day can promote healing and reduce discomfort.


Topical treatments: Applying prescribed ointments or creams can help heal the fissure and alleviate pain.


In cases where these methods are ineffective, more advanced treatments may be necessary, such as:


Botox injections: These can help relax the anal muscles, allowing the fissure to heal.


Surgical intervention: A procedure called lateral internal sphincterotomy may be recommended, where a small portion of the anal sphincter muscle is cut to reduce pressure and allow healing.


Preventing anal fissures

Prevention strategies include maintaining a healthy diet high in fibre, staying well-hydrated, and avoiding straining during bowel movements. Regular exercise can also promote healthy digestion and bowel habits.


Mr Andrew Brian Williams is an esteemed colorectal surgeon. You can schedule an appointment with Mr Williams on his Top Doctors profile.

By Mr Andrew Brian Williams
Colorectal surgery

Mr Andrew Brian Williams is a highly established consultant general and colorectal surgeon, with over 30 years of experience, based in London. He treats a whole host of ailments and performs a wide range of surgeries, possessing expert knowledge in anal fistula, proctology and fissures, alongside haemorrhoids, pelvic floor dysfunction, including constipation, obstructed defaecation, incontinence and OASI and inflammatory bowel disease.

Mr Williams studied medicine at the University of London, graduating in 1991 with a MBBS. Following this, he commenced surgical training at the South East region of London at Guy's and St Thomas'. He completed his training in the South East region and up until recently worked in the NHS at Guy’s and St Thomas’. He is also interested in research, completing a period of research at St Mark's culminating in a Master’s degree in 2002. Keeping his interest in research he has supervised a number of successful higher degrees and has over 100 peer-reviewed papers to his name.

Mr Williams also enjoys educating his peers, undertaking teaching on the pelvic floor, in particular, anal and pelvic floor ultrasound scanning. He has a special interest in inflammatory bowel disease, complex anal sepsis and pelvic floor disorders. He established the pelvic floor unit of St Thomas’ Hospital, which serves the whole of South East England for complex pelvic floor services, treating over 900 patients per year. This unit he extended to involve London Bridge Hospital so that his private patients could benefit from the same service.

He has set up a fully private multidisciplinary service and MDT for patients with complex multicompartment pelvic floor symptoms. This involves the full pelvic floor team, including Urogynaecology, Urology, Radiology, physiotherapy, nursing and dietetics. Mr Williams is a member of multiple medical associations, including the Association of Surgeons of Great Britain and Ireland and the Association of Coloproctology of Great Britain and Ireland, and Pelvic Floor Society (PFS). He is the past president of the PFS and has been heavily involved in the societies response to problems following the insertion of pelvic floor mesh. For this work he has recently been awarded the Geoff Oaks medal for “substantial contribution to Coloproctology in GB and Ireland.

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