Anal Fissure - What Can I Do About It?

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Anal Fissure - What Can I Do About It?
Anal Fissure - What Can I Do About It?

Video: Anal Fissure - What Can I Do About It?

Video: Anal Fissure - What Can I Do About It?
Video: How to get rid of Anal Fissures? 2023, March

Anal fissure

The anal fissure is one of the most common proctological diseases. It is a longitudinal tear in the anal canal. The anal fissure can occur at any age, but most commonly occurs between the ages of 30 and 50. Men and women are affected roughly equally.


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  • causes
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  • How are the costs going to be covered?


There are several causes for an anal fissure to develop:

  • mechanical damage to the epithelium due to constipation, diarrhea or manipulation;
  • Spasticity of the sphincter;
  • local infections;
  • existing neuromuscular dysregulations that cause an increased state of tension in the sphincter muscle.

Typical is the pain-related high sphincter tone, which makes it difficult to settle the stool and then becomes even stronger due to the burning sensation. The result is an ever deeper tear.

Systemic diseases such as inflammatory bowel diseases (e.g. Crohn's disease) or infectious diseases (e.g. tuberculosis, syphilis) can cause the development of an anal fissure. In these cases, we speak of secondary anal fissures.


An acute anal fissure occurs suddenly and for a short period of time and manifests itself as a narrow, one to three centimeter long, elongated tear with sharply defined wound edges. It usually heals spontaneously or with conservative therapy.

A chronic anal fissure is present if the disease has persisted for more than six weeks and a hypertrophic anal papilla appears as a typical sign at the inner end of the anal canal and on the outside of the outpost fold. The wound edges are usually hardened, and at the bottom of the chronic fissure there is often a small fistula duct with an abscess between the sphincter muscles. This form does not heal on its own without adequate therapy.


In the foreground is a stabbing, sharp pain that occurs with the bowel movement, which lasts for several minutes and then turns into burning for hours. Usually this is combined with blood on the stool or toilet paper. Heavy bleeding can sometimes occur. In the chronic course, oozing and itching in the anal area occur.


The diagnosis can be made based on the anamnesis and a physical examination with inspection and palpation. In the acute stage, a rectoscopy is not absolutely necessary and should only be performed after three weeks of therapy due to the pain. With this examination, the extent of the defect can be determined; other changes may also be visible. If the findings are unclear, an examination should be carried out under anesthesia.


A key measure is stool regulation. This also reduces the risk of anal fissures recurring.

  • In many cases, the acute anal fissure heals on its own. The use of suppositories for targeted emptying in combination with analgesic ointments can alleviate the symptoms, break through the sphincter spasm and thus promote the healing process. For patients with constipation, stool softeners, fiber-rich foods and shower baths are recommended.
  • Chronic fissures are treated with various methods that aim to reduce the increased resting pressure in the anal canal. Muscle-relaxing ointments with e.g. diltiazem, nifedipine or trinitrate are used locally. If the muscle tone is extremely high, botulinum toxin can be injected.

If the therapy is not successful, an operation is necessary. The entire scarred, chronically inflamed tissue is removed and the wound is left open. Complete healing takes about three to four weeks. A division of the internal sphincter was previously common, but should no longer be performed because of the risk of continence disorder.

Whom can I ask?

If you have complaints in the anal region, you can contact your family doctor or a proctologist.

How are the costs going to be covered?

All necessary and appropriate therapeutic measures are taken over by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

You can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

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