Anal fissure

What you should know about anal fissures: symptoms, causes and treatment – the essentials compact and understandable.


Anal cracks


Man with anal fissure

Anal fissures or anal fissures are tears in the skin and intestinal mucosa in the area of ​​the anus, on which ulcers form. Anal means “regarding the anus”, fissure is derived from the Latin fissura and means tear. Doctors distinguish between acute anal fissures and chronic anal fissures.


The most striking symptom of anal fissures is severe stinging or burning pain during or after bowel movements. Typically, the anal sphincter is compressed so much due to pain that only pencil-thin stool is excreted. Similar to hemorrhoids, itching and burning in the anus often occur. In addition, there is often slight bleeding, which can be recognized by light red marks on underwear or toilet paper.


Because of the similarity, anal fissures are often confused with hemorrhoids. This can make healing difficult. Because the longer acute anal fissures are not treated, the more the risk of complications increases. The most common complication of anal fissures is permanent narrowing of the sphincter. These arise when those affected hold back their bowel movements for fear of pain. With the result of increasing pain – and even more stool urge suppression.

This avoidance behavior then also damages the intestinal mucosa. The restrained stool exerts more and more pressure in the intestine. This leads to pain, but also hurts the intestinal mucosa itself. It is not uncommon for the wound area to become scarred and change in connective tissue with a subsequent loss of elasticity in the sphincter. The fold of skin on the anus may thicken. Doctors speak of outpost folds or skin tags. Or there is a chronic anal fissure. Sometimes polyps (fibromas) form around the chronic anus ulcer. In the worst case, fistulas form that can grow into the intestine or even beyond the intestinal wall.


The causes of anal fissures are not exactly clear. However, they occur increasingly in people with chronic intestinal diseases such as Crohn’s disease or ulcerative colitis. Persistent diarrhea, constipation and hemorrhoids as well as anal sex practices also favor anal fissures. In addition, the anal mucosa can tear after birth.


Acute anal fissures often heal within a few days to weeks. Local anesthetic ointments with active ingredients such as lidocaine and cinchocaine or polidocanol work against the annoying symptoms. Special ointments with active ingredients such as nitroglycerin or calcium channel blockers such as diltiazem and nifedipine relax the sphincter and promote its circulation. In addition to drug therapy, stool-regulating measures are important. In the case of anal fissures, a permanently soft-shaped chair should be achieved, which can be removed easily.

Severely scarred anal fissures, outpost folds, fibromas and fistulas can often only be treated with a surgical intervention.


If symptoms of bowel movements do not subside after 2 to 3 days, a medical examination is urgently recommended. On the one hand, the symptoms should be alleviated as early as possible to avoid complications. On the other hand, the symptoms can indicate serious illnesses that must be excluded or treated.

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