Anal fissures are caused by cuts or tears in the lining of the anus. They are sometimes confused with hemorrhoids and are almost as common. Fissures can occur at any time, but are more common for people under the age of 50.
Anal fissures cause sharp pain, which can be severe, during and after bowel movements. Other symptoms include bright red blood in the stool, in the toilet, or on the toilet paper, as well as spasms in the sphincter muscles. Fissures can also cause a sentinel pile to develop, which is a skin tag near the fissure that is sometimes confused with a hemorrhoid.
Fissures develop because of diarrhea, hard, dry bowel movements, straining during bowel movements, trauma to the anus, or diseases that cause inflammation in the anal or rectal areas. Some anal fissures can be treated with dietary changes, increasing fluid intake, soaking in a warm bath, and medication which are usually topical or suppositories.
Other fissures are chronic and if they do not heal with basic treatment may require a surgical procedure called a sphincterotomy. During this procedure, a small amount of the internal anal sphincter muscle is cut, which decreases the spasms and promotes healing of the fissure.