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An anal fissure is a linear tear in the anal skin most commonly caused by passage of a large, hard stool. This condition is among the most common anorectal disorders. Fissures can also occur with severe bouts of diarrhea or inflammation. This results in the anus becoming dry and irritated, causing it to tear. Injury to the anal area during childbirth may be another cause.
A fissure can be quite painful during and immediately following bowel movements. This is because the anus and anal canal are surrounded with muscles that control the passage of stool and to keep the anus tightly closed at other times. When those muscles expand, it tears the fissure open. There may also be bleeding or itching with an anal fissure.
A simple visual examination of the anus and surrounding tissue usually reveals the fissure. It is quite tender when examined and is most often located in the middle of the posterior (back) section of the anus.
Most fissures heal either by themselves or with non-surgical treatment. If the fissure is not responding to treatment, there are conditions, such as muscle spasm or scarring, which could interfere with the healing process. Fissures that do not heal can be corrected with surgery. It is a minor operation done on an outpatient basis.
Over 90 percent of the patients who need surgery for fissures have no further problems. Patients can help avoid the return of fissures by maintaining adequate fiber in the diet. This prevents constipation, which is the most frequent cause of fissures.
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