Fissure in Ano or Anal Fissure is a break or tear in the skin of the anal canal. It may be acute or chronic. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location.

Fissures may be caused by constipation, the passing of large, hard stools, or by prolonged diarrhoea. In older adults, anal fissures may be caused by decreased blood flow to the area.Other common causes of anal fissures include childbirth trauma in women, Inflammatory Bowel Disease (IBD), poor toileting in young children. In rare cases, an anal fissure may develop due to anal cancer, HIV, tuberculosis, syphilis.

Symptoms

• Painful defecation
• Bleeding per rectum or blood in toilet paper
• Itching/ burning sensation
• a skin tag, or small lump of skin, next to the tear

Treatment

• Medical Management – include stool softeners, topical pain relievers like Lidocaine, applying a ointment to the anus to promote blood flow to the area or a hydrocortisone cream to help with inflammation, high fibre diet and hot fomentation/ sitz bath.
• Surgical Treatment - Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for and have not healed. It is not the first option in treatment. The main concern with surgery is the development of anal incontinence.Two of the common used procedures are Lateral Internal Sphincterotomy and Anal Dilatation (lord’s procedure)