Many infants will develop an anal fissure during the first year of life, while older adults will get them because of poor circulation or a diet lacking fiber. Decreased blood flow in the area is a common problem that causes problems with elimination.

Some anal fissures that don’t heal are considered chronic and need to be treated with surgery. Having one anal fissure increases the risk of having others. Complications can include tears in the ring of muscle called the internal anal sphincter, making it difficult for the fissure to heal and causing extreme pain that requires surgical intervention.

Diagnosis and Treatment

Doctors will undertake a complete physical exam to understand the condition, with a special focus on diet and lifestyle. Typically, patients are encouraged to drink more water, added fiber to the diet and begin exercising regularly. Laxatives sometimes will be recommended in cases of extreme constipation.

Fortunately, most anal fissures are relatively easy to diagnose. The tear is usually visible during the examination, usually by means of an anoscope, a short, lighted tube that will illuminate the area in the anal canal where the fissure is believed to be located. The location of the fissure is important -- a fissure on the side of the anal opening may be a sign of another issue, such as Crohn’s disease or other irritable bowel syndrome condition.

If an underlying condition is suspected, additional testing is usually recommended. These can include a flexible sigmoidoscopy, which examines the bottom portion of the colon with a tiny video camera and light; and a colonoscopy, wherein a flexible tube is used to inspect the entire colon. This is done to detect colon cancer and signs of other conditions in the presence of abdominal pain or extreme diarrhea.