Complaints & connections · borters.ch
A small tear with great pain — soft stool is the most important treatment.
Also known as: anal fissure
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A small, very painful tear in the anal lining — sharp pain during and after passing stool, often with a little bright-red blood. Usually from hard stool or straining. Often heals on its own with soft stools (fibre, water), warm sitz baths and relaxing ointments; stubborn cases need medical treatment.
Fissure and eczema keep each other going: the split weeps, the skin gets sore, scratching opens it again.
Sit for ten minutes in hand-warm plain water, once or twice a day, then dab dry gently.
One to two tablespoons of ground linseed or a tablespoon of psyllium husks with at least 250 ml of water, once a day.
An acute fissure heals in about half of people within six weeks if the stool is kept soft — that is the most important part, because hard stool tears the split open again and again. Ointments with nitrates or diltiazem relax the sphincter and raise the healing rate to about seven in ten over six to eight weeks. From six weeks it counts as chronic. Sitz baths work through the same muscle relaxation.
Ointments with nitrates or diltiazem relax the sphincter so that circulation reaches the tear — they are not painkillers, and nitrates cause headaches in some people. The application runs six to eight weeks. Cortisone ointment is not the route here: it thins the skin and delays healing. What belongs to it in every case is soft stool — without that, the tear opens again with every bowel movement.
A sharp, burning pain during the bowel movement, often described like broken glass, with a little bright red blood on the paper. The difference from haemorrhoids lies in the pain.
After the bowel movement a cramping burn stays for minutes to hours. That is the ring muscle going into spasm — and this spasm keeps the wound open.
Because it hurts, going is put off; the stool gets harder, and the next time hurts even more. Breaking this circle matters more than any ointment.
The ordinary fissure lies at the back in the midline. If it sits to the side, if there are several, or if it does not heal over weeks, other reasons are looked for — Crohn’s disease and infections among them.
Besides the sharp pain on passing stool, a burning and itching stays afterwards — the wound is small but very sensitive.
A fissure bleeds bright red and little. If the bleeding leads to anaemia, a second source is looked for rather than simply carrying on with treatment.
With fissures in an unusual place, several at once or with poor healing, a chronic bowel inflammation belongs considered.
Soluble fibres like psyllium and oats bind water and make the stool supple. Wheat bran and a lot of raw vegetables, by contrast, increase bloating and pain in a sensitive gut — this distinction explains most of the failures.
Fibre without water makes the stool harder instead of softer. The two belong together, and the effect only sets in after some days.
Draws water into the bowel and therefore works with a sluggish stool. The belly shows the upper limit: if the stool gets too loose, the dose at once was too high.
Yoghurt, kefir, sauerkraut and the like bring living cultures with them. Many tolerate them well; with a strongly bloated belly they can also do the opposite in the first weeks.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Hard stool is the cause, and it becomes more common in the second half of the cycle and in pregnancy — this hormone slows the gut. Soft stool over weeks is therefore the actual treatment, not the ointment.
The fissure heals if it is not torn open again each time. 25–30 g fibre a day and 1.5–2 litres of fluid is the studied frame; most acute fissures close in 4–6 weeks.