We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Anal Fissure FREE

Deborah Tolmach Sugerman, MSW
JAMA. 2014;311(11):1171. doi:10.1001/jama.2014.214.
Text Size: A A A
Published online

An anal fissure is a tear in the opening of the anus that can cause pain, itching, and bleeding.

Anal fissures are common in infants but less so in older children. They occur in adults of all ages. The pain, which can be quite severe, usually occurs during and after a bowel movement. The most common cause of anal fissures is constipation, but diarrhea can be a cause as well. Anal fissures often result from a cycle in which you have pain as a result of constipation, avoid having a bowel movement, and thus worsen the constipation. Treatment involves changing your diet to eliminate diarrhea or constipation, or topical medications to help heal the tear. However, some people need surgery to treat an anal fissure. Anal fissures are not associated with cancer, but you should always talk to your doctor if you have bleeding with a bowel movement.


The most common symptoms are pain when having a bowel movement and blood on the toilet tissue. Acute anal fissures usually get better quickly. A chronic fissure, which can be more difficult to treat, is one that has lasted more than 6 weeks.

A doctor can usually easily see if you have an anal fissure. To make the diagnosis, he or she might use an instrument called an anoscope to examine the anal canal.


Constipation can cause the skin of the anus to tear. When that happens, the pain of a bowel movement can cause spasms in the anal sphincter muscle. This in turn means that less blood flows to the area, making it more difficult for the fissure to heal. The pain can also cause people to resist having a bowel movement, which worsens the constipation. Other causes include diarrhea and Crohn disease.

If you have anal pain for more than 10 days, you should see a doctor to rule out an infection, a complication of inflammatory bowel disease, a hemorrhoidal condition, or anal cancer.


Home and over-the-counter treatments include sitting in a warm bath; treating constipation with a high-fiber diet, a fiber supplement, and plenty of liquids; and nonprescription ointments including petroleum jelly, 5% lidocaine or 2.5% lidocaine plus 2.5% prilocaine, zinc oxide, or 1% hydrocortisone cream.

A second line of treatment may be prescription-strength topical ointments containing medications such as nitroglycerin, diltiazem, or nifedipine to relax the sphincter muscles.

Another treatment option is surgery, usually done in an outpatient setting. One type of surgery involves injecting botulinum toxin into the anal sphincter. Another kind of surgery involves an operation to cut a small portion of the internal anal sphincter. This improves blood flow to the tear and reduces spasm. Surgery does not heal the tear but is usually successful in preventing anal fissures from recurring.

Box Section Ref ID

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish. A Patient Page on constipation was published in the October 2, 2013, issue.


The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: McQuaid KR. Gastrointestinal disorders. In: Papadakis MA, McPhee SJ, Rabow MW, Berger TG, eds. Current Medical Diagnosis and Treatment 2014. New York, NY: McGraw-Hill; 2013:chap 15.

Topic: Digestive System



Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Spanish Patient Page: Fisura anal

Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Collections