Dr. Ritha Belizaire, board-certified colorectal surgeon and Founding Clinical Advisor of Betty Health, explains anal fissures – what they are, how they form, and how to treat them.
Video Summary:
What is an Anal Fissure?
An anal fissure is essentially a small cut on the skin of the anus.
Why does this happen?
It usually occurs because the anal sphincter muscle is too tight. When this muscle squeezes too much, it reduces blood flow to the tiny vessels that nourish the skin of the anus. Without enough blood supply, the skin becomes fragile and can tear, leading to a fissure.
Anal fissures can sometimes develop after passing a large bowel movement or from chronic diarrhea. Certain systemic conditions, such as Crohn’s disease, can also cause fissures, though these are different from the more common everyday type.
Symptoms
- Severe pain during bowel movements
- Bright red bleeding
- Anal pain that is often mistaken for hemorrhoids
It’s important to note that fissures and hemorrhoids are treated very differently.
Treatment Options
The goal of treatment is to relax the anal sphincter muscle so blood can flow freely and the skin can heal. Treatments may include:
Topical ointments – Often prescribed by a compounding pharmacy to help relax the muscle.
Botox injections – Administered into the internal sphincter (usually under anesthesia) to temporarily relax the muscle.
Lateral internal sphincterotomy – The most aggressive option, where a colorectal surgeon makes a small cut in the sphincter muscle to permanently reduce tension and restore blood flow.
When to See a Doctor
If you’re experiencing anal pain, bleeding, or any of the above symptoms, it’s important to consult your primary care doctor, a gastroenterologist, or a colorectal surgeon. Proper diagnosis is key to receiving the right treatment and relief.