Anal fissure

What is an anal fissure?

Anal fissure is a condition affecting all age groups. It is an acute tear or a chronic ulcer^a in the tissue of the anal canal below the dentate line.

What are the symptoms of anal fissure?

Anal fissure is extremely painful during and following a bowel movement. The pain can last for several minutes to several hours and can be accompanied by a small amount of bleeding (bright red in colour). Fissures often are a chronic or recurring problem.

If these symptoms are present, consult your health care professional.

What are the mechanisms underlying anal fissure?

Decreased blood flow in anal lining and traumatic events have been suggested to be involved in anal fissure.^(7,8) Also, anal fissures are believed to be caused by hard, dry or large bowel movements^(9,10) or severe bouts of diarrhea.

Anal fissure during pregnancy or following delivery

Is anal fissure frequent in pregnancy or following delivery?
About 10-15% of women experience anal fissure during pregnancy or following delivery.^(3,11,12,13)

When does anal fissure begin?
In most cases, anal fissure occurs during the first two months following delivery.^(3,13)

Heavy weight babies, long labour, and anal incontinence following delivery are associated with anal fissure. However, a caesarean section does not protect against anal fissure.⁽³⁾

Difficulty in completing rectal evacuation (terminal constipation) is strongly associated with anal fissure. This condition is the most important factor for anal fissure in pregnant women.^(3,11)

Late delivery is another independent risk factor for anal fissure.⁽³⁾ Forceps deliveries and damage to the area surrounding the anus are also associated with anal fissure.⁽¹³⁾

Ulcer: A local defect of the surface of an organ or tissue.