A hard dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the anorectal area.

At least 50 percent of fissures heal either by themselves or with non-operative treatment, including application of special medicated cream, use of stool softeners, avoidance of constipation, and the use of sitz bath (soaking the anal area in plain warm water for 20 minutes, several times a day).

A fissure that fails to respond to treatment should be re-examined to determine if a definitive reason exists for lack of healing. Such reasons can include scarring or muscle spasm of the internal anal sphincter muscle. Those which continue to cause pain and/or bleeding can be corrected by surgery.

Surgery may consist of a small operation to remove the fissure and the underlying scar tissue. Cutting a portion of one of the anal muscles helps the fissure to heal by preventing pain and spasm, which interferes with healing. Cutting this muscle rarely interferes with the ability to control bowel movements and can usually be performed without an overnight hospital stay.

Complete healing occurs in a few weeks, although pain often disappears after a few days. More than 90% of patients who require surgery for this problem have no further trouble from fissures.

Fissures do not lead to colon cancer, but persistent symptoms need careful evaluation, however, since conditions other than fissure can cause similar symptoms.

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