What are Anal Fissures? Symptoms, Causes, and Treatments

The Relationship Between Hemorrhoids and Fissures

There is no single cause of hemorrhoids and anal fissures. Most often they are caused by excess pressure on the anal canal. Treatments for fissures include some simple lifestyle changes and pain management treatments, including over the counter creams and, sometimes, prescription vasodilators. Some of the causes of fissures, as well as hemorrhoids, include:

• Chronic, ongoing constipation
• Straining during bowel movements
• Diarrhea
• Pregnancy and childbirth
• Sitting too long on the toilet
• Strenuous exercise or heavy lifting
• Aging

Anal Fissure or Hemorrhoids? What’s the Difference?

The difference between anal fissures and hemorrhoids is that hemorrhoids are caused by pressure in the anus and fissures are caused by repeated trauma to the site, whether the hemorrhoids or anal fissure are present at the same time. Hemorrhoids and fissures together likely means that your hemorrhoids have made you susceptible to fissures, as an inflamed hemorrhoid can get in the way of a stool’s path out the anus.

The friction of the stool on the inflamed hemorrhoid is typically what causes the fissure tear. For hemorrhoid fissure treatment, it’s highly recommended to first treat the swelling of the hemorrhoid in order to get the hemorrhoid out of the pathway of future stools.

What are Fissures (or Anal Tears)?

Tears are often caused by trauma, like the passage of a hard stool, repeated diarrhea, childbirth, narrowing of the anal canal or ulceration of a hemorrhoid. Tears that do not heal become fissures due to inflammation from repeated trauma and coexisting factors such as internal hemorrhoids.

Fissures should be treated with an ointment that both soothes symptoms and offers protection from further damage and repeated trauma. Protectant qualities can be found in active ingredients like Lanolin and Glycerin, and a common active ingredient for anorectal pain relief is Lidocaine. There are others, but these are common. Treating the pain and protecting the fissure from further damage will help to speed up recovery.

Many times, fissures are caused by internal hemorrhoids. In that case, you will want to treat those hemorrhoids in order to stop the recurrence of the fissure. Use an ointment or cream for internal hemorrhoids in order to treat that underlying condition.

Oftentimes, hemorrhoid ointments contain vasoconstrictors like Phenylephrine, which should not be used on a fissure. Make sure to apply these ointments internally, above the fissures. These ointments will ultimately help your fissures by treating the underlying condition, but for pain management of the fissure itself you should opt for a Phenylephrine free ointment or cream.

Main Causes of Anal Fissures

Hemorrhoids and fissures together is caused first and foremost by the hemorrhoid. Without the swelling of the hemorrhoid it’s less likely that a tear would have formed. This is because the swollen hemorrhoid is typically struck when it’s in the way of a bowel movement during a bathroom visits or it’s rubbed by toilet paper when wiping. These actions can tear the skin, especially when repeated over and over again. The causes of fissures include:

1. Wiping irritated external hemorrhoids skin during bathroom visits with toilet paper
2. Using rough toilet paper
3. Excessive and rough wiping
4. Stools rubbing swollen internal hemorrhoids during bowel movements
5. Especially hard stools during bowel movements