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An anal fissure is a small tear or cut in the skin lining the anus. Symptoms of an anal fissure are extreme pain during bowel movements and red blood bleeding with bowel movements. Causes of an anal fissure include hard dry bowel movements, diarrhea, inflammation, trauma, and altered bowel habits. Once a cut forms, it causes the sphincter, the muscle around the anal opening, to spasm. These spasms make it hard for the cut to heal and can cause the pain to last for some time after a bowel movement.

An acute fissure (new onset) is treated without surgery. With a change in bowel habits, more than 9 out of 10 will heal. These changes include eating a diet high in fiber, drinking more water, stool softeners and taking a bulk fiber such as Metamucil®. These changes allow you to pass soft stool and avoid constipation. Take warm baths for 10-20 minutes several times a day to sooth and relax the anal muscles. Your doctor may also give you creams to help. 

A chronic fissure (lasting more than a month or one that heals and comes back) may require surgery. We offer two types of surgeries. One is a sphincterotomy which involves a minor cut of the internal anal sphincter muscle. This treatment helps the fissure to heal by decreasing pain and spasms. Cutting the muscle rarely causes problems with bowel control. The other type of surgery involves injecting Botox®, or a muscle relaxer, into the sphincter muscle to decrease the spasms and pain. You will need a few weeks to completely heal from these surgeries, but you will likely have less pain within a few days. 

Day Before Surgery

You may need to complete a bowel prep before surgery to clear the intestines of stool. We will discuss the details with you.

After Surgery

Take a sitz bath at least 3-4 times a day and after each bowel movement. A sitz bath is sitting in a bathtub of warm water for 10-20 minutes. This will help decrease the pain of muscle spasms and help you heal.

Pain 

Your doctor may order pain pills. Follow the directions from the pharmacist. You may keep using the cream as needed for 1 month. 

After surgery you will take a stool softener (docusate sodium) and a bulk fiber laxative such as Metamucil® to prevent constipation. You can buy these without a prescription. 

Diet

Eat a high fiber diet each day.

  • Drink 8-10 (8 oz) glasses of caffeine-free fluid 

  • Eat at least 4 servings of fruits and vegetables.

  • Eat at least 4 servings of whole grain bread and cereal.

Activities

  • Change your position from sitting to standing to lying for comfort. 

  • You may return to work when you feel ready.

  • No driving while taking prescription pain pills.

  • You may resume sex when you feel ready.

  • You will return to the clinic to see your doctor, NP or PA in 1 – 3 weeks.

When to Call 

  • Large amount of bright red blood that does not stop with pressure to the area for 10 minutes.

  • Fever over 100.4º F for 2 readings, 4 hours apart. Check for a fever once daily at the same time each day for a week.

  • Foul-smelling drainage.

  • Excess swelling.

  • You cannot control bowel movements.

  • Trouble passing urine.

Who to Call

Digestive Health Center: 608-242-2800

After hours, weekends or holidays ask for the doctor on call. Leave your name and phone number with area code. We will call you back.

The toll-free number is: 855-342-9900. 

If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.