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Anal fissures

Anal fissures


Fissures are small lesions of the skin and mucous membranes. They present themselves as small linear cuts that are formed mainly around the nails, at the corners of the mouth, behind the ears, around the nipples and in the anal region. Anal fissures are a disease that is common in the population and affects both sexes with a slight male prevalence. It is a more or less deep ulceration, a few millimetres long, which is formed at the border between the skin and the anal canal and tends to become chronic.

Factors which have a major influence on the formation of anal fissures can be numerous, however there are some more predisposing conditions:

  • constipation;
  • chronic diarrhoea;
  • poor personal hygiene;
  • trauma;
  • sexual habits.



An anal fissure is characterised by three main symptoms: pain, anal contracture and the presence of a small ulceration. These may be associated with sometimes uncontrollable anal itching and wet anus.
Pain, sometimes associated with slight red blood loss, is the main symptom that most frequently alarms the patient. It usually manifests itself as intense “burning” in the anal area, which manifests itself mainly in the night hours and during defecation. It becomes acute at the passage of the faeces, to then attenuate for a short interval of a few minutes and then resume, with different degrees of intensity, in the following hours.


Consulting a proctologist and to making an early diagnosis is essential to avoid the chronicisation of the anal fissures, which takes place quite quickly. In chronic fissures, indeed, a vicious circle (characterized by hypertone – pain – further contraction of the sphincter) is triggered, which is difficult to resolve with the administration of drugs alone.

A specialist may often suspect the presence of an anal fissure just by listening to the symptoms reported by the patient. Even if careful observation of the signs and symptoms reported may already allow a diagnosis, a proctological evaluation must be carried out and it is always necessary to exclude the presence of other more important pathologies.

The diagnosis is quite simple and does not require particularly sophisticated instruments: indeed, in most cases, the fissure is already visible through a first widening of the anus. A delicate digital rectal examination must then be carried out which, given the possibility of causing pain, must be performed with particular caution and be followed by observation with the aid of an anoscope.


The main aim of anal fissures medical therapy is the elimination of the anal sphincter contracture and is based on the use of creams and ointments useful to relieve pain and to favour relaxation of the anal muscles, associated with a high-fibre diet and lukewarm washings.
If these treatments do not bring benefits and the anal sphincter is still contracted, the specialist may prescribe the use of appropriate anal thermal dilators or balloon dilators, specifically studied and realised to obtain a progressive recovery of the elasticity of the anal sphincter, to allow wound healing and the disappearance or improvement of the symptoms.
The proctologist will only consider a day surgery operation if the anal fissures do not respond effectively to any of these therapies.


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