Patient information from BMJ

Anal tears

Last published:Jul 24, 2020

Anal tears (the medical name is anal fissures) can be very painful, but they usually heal after some simple treatments. If they don't get better you may need extra treatment.

You can use our information to talk to your doctor and decide which treatments are best for you. This leaflet covers anal tears in adults.

What are anal tears?

Anal tears are small rips in the skin of your anus. The anus is the opening from which stools (feces) come out of your body. A tear here makes passing stools very painful.

Some people get anal tears if they pass hard, dry stools, or if they are constipated. Diarrhoea may also cause tears in some people.

It's unusual to have more than one tear at a time. If this happens, your doctor may do some tests to see if you have another problem such as an infection.

Anal tears often heal on their own. But some tears don’t heal for six weeks or more. These are called chronic anal tears. Doctors think that some tears don't heal because the muscle that controls the anus tightens up (goes into spasm). The tightness stops blood getting to the anus. This prevents healing.

What are the symptoms?

If you've got an anal tear, the main things you'll notice are pain, and blood in your stools.

The pain you get can be sharp and intense. It may last for an hour or more after you've been to the toilet. There will be some blood, although probably not much. The blood will be bright red.

Sometimes a small lump or swelling appears at the end of the tear furthest from the anus. Because anal tears bleed and there's swelling around the tear, they're often mistaken for haemorrhoids (clusters of swollen blood vessels, sometimes called piles).

What treatments work?

There are some things you can do yourself that may help your anal tear to heal. But if these don't work, your doctor may suggest some ointment or an injection. If these don't work, you may need a small operation.

Things you can do for yourself

The first thing to try is eating a high-fibre diet. Fibre is food that can't be broken down by the body. It makes your stools softer and more bulky and easier to pass. Foods high in fibre include fresh vegetables and fruit, wholegrain cereals, wholemeal bread, and wholemeal pasta.

You should also make sure that you are drinking enough water. This might help you avoid becoming constipated and make passing stools easier.

Having frequent warm baths helps ease the pain caused by the tear and helps to relax the anal muscle.

Ask your doctor whether you should try laxatives if you are constipated.

Medical treatments

If changes to your diet don't help, your doctor might prescribe an ointment that you rub on your anus. It helps to open up your blood vessels. This improves the blood flow to your anus, which helps healing.

For tears that don't heal with other treatments, doctors sometimes suggest injections of botulinum toxin (Botox) into the muscle of the anus.

Botox works by making the muscle in the anus weaker so that it's less likely to tighten up. You may get some pain and bleeding after Botox injections. Some people get other side effects from this treatment, such as not being able to control their gas or their bowels for a week or so afterward.

If you use GTN or CCB ointments you will need to continue the treatment for six to eight weeks.

Surgical treatments

Doctors might suggest surgery for people whose anal tears don't get better with other treatments.

There are two types of operation for anal tears. They are both simple operations and can be done with a local anaesthetic.

The most common is surgery on the anal muscle. This operation is called an internal anal sphincterotomy. The surgeon makes a small cut in the anal muscle to weaken it, so it's less likely to tighten up. It works to heal anal tears in most people.

This surgery can have side effects. It's quite common for people to lose some control over their bowels (incontinence) for a while after this surgery. And many people have flatus incontinence. This means they can't fully control gas coming from their anus. But these problems are temporary.

The other type of operation is called an anal advancement flap. The surgeon stitches healthy skin over the tear. It doesn't seem to work as well as sphincterotomy but there is no risk of incontinence with this technique.

What will happen to me?

Most people with an anal tear get better with simple treatments such as taking warm baths and changing what they eat. This usually happens in six to eight weeks.

Chronic tears are less likely to heal with these treatments. Most people who have chronic tears need medical treatments to help relax the muscle that controls their anus.

Surgery works for most people who need it. But some of these people may get tears again afterwards.