Materiały źródłowe

• #1 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement. Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures. […] Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool. […] Initial minor tears in the anal mucosa due to a hard bowel movement probably occur often. In most people, these heal rapidly without long-term sequelae. In patients with underlying abnormalities of the internal sphincter, however, these injuries progress to acute and chronic anal fissures. […] The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.

• #2 Anal Fissures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526063/

  Anal fissures are common in those with a history of constipation or hard stools, low fiber diet, trauma, and previous anal surgery. […] Causes of anal fissures commonly include constipation, chronic diarrhea, sexually transmitted diseases, tuberculosis, inflammatory bowel disease, HIV, anal cancer, childbearing, prior anal surgery, and anal sexual intercourse. […] The majority of acute anal fissures are thought to be due to the passage of hard stools, sexually transmitted infection, or anal injury due to penetration. […] Underlying conditions such as inflammatory bowel disease, tuberculosis, HIV, anal cancer, and prior anal surgery are predisposing factors to both acute and chronic atypical anal fissures.

• #3 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

• #4 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  An anal fissure is a crack or tear in the lining of your anal canal. Trauma causes the lining to tear, causing acute pain and bleeding. Anal trauma usually causes a fissure, especially from straining to pass hard stools. […] Trauma like stretching and straining causes your anal lining to tear. But preexisting conditions can also play a role. […] Primary causes of anal fissures include: Chronic constipation and straining to poop. […] Other contributing conditions include: Prior surgery. […] Anal fissures can occur suddenly or gradually. They can also heal quickly or slowly.

• #5 Anal fissures: Symptoms, causes, and treatment options – Harvard Health

  https://www.health.harvard.edu/diseases-and-conditions/anal-fissures-symptoms-causes-and-treatment-options

  Anal fissures are typically caused by constipation and straining to pass hard stools. […] They can also result from diarrhea, vaginal childbirth, or infections. […] The most common causes of anal fissures are constipation and diarrhea. Other causes of anal fissures include having a tight anal sphincter muscle, inflammatory bowel disease, trauma to the anus, anal intercourse, vaginal childbirth, infections in the area of the anus, and, rarely, tumors.

• #6 Anal fissure: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/what-is-anal-fissure-and-what-causes-it

  An anal fissure is a tear in the lining of the anal canal, or a cut or tear in the anus region, that extends into the anal canal. It can result from constipation, anal sex, infections, and other factors. […] Damage to the lining of the anus is a common cause. […] They can be idiopathic (no known cause). […] Anal fissures can happen for a number of reasons. […] Constipation: Large, hard feces (stools) are more likely to result in lesions in the anal area during a bowel movement than soft and smaller ones. […] Diarrhea: Repeated diarrhea can cause an anal fissure to develop. […] Muscle spasms: Experts believe that anal sphincter muscle spasms may increase the risk of developing an anal fissure. […] Pregnancy and childbirth: Pregnant females assigned at birth (FAAB) have a higher chance of developing an anal fissure towards the end of their pregnancy.

• #7 The Most Common Causes of Anal Fissures: Robert G Yavrouian, MD, FACS, FASCRS: Colon and Rectal Surgery

  https://www.lacolorectalsurgery.com/blog/the-most-common-causes-of-anal-fissures

  An anal fissure, which is a crack or tear in the lining of the anus, is a common but painful condition. […] Several factors can trigger anal fissures, including: […] Constipation is the leading cause of anal fissures and can result from diet, certain medications, dehydration, and lack of exercise. Hard bowel movements increase the risk of tearing the anal lining. […] Do you strain when having bowel movements? Even if you aren’t constipated, straining puts extra pressure on the anal lining, increasing the risk of a fissure. […] Between 1% and 5% of Americans have chronic diarrhea or loose stools. Diarrhea often contains more stomach acid and digestive enzymes than normal bowel movements, and the frequency at which it occurs increases the risk of anal irritation and tissue damage. […] Certain sexual activities, like anal sex and inserting objects into the anus, increase the risk of fissures. […] The anal sphincter experiences significant pressure during vaginal delivery, which can damage the delicate lining of the anus. This isn’t a risk for every pregnancy, but it’s more likely with large babies and difficult deliveries.

• #8 The Most Common Causes of Anal Fissures | Colon and Rectal Surgeons & Proctologists in Merrifield and Fair Oaks, Fairfax, Alexandria, Gainesville and Lansdowne, VA | Fairfax Colon & Rectal Surgery, PC

  https://www.fairfaxcolorectal.com/post/the-most-common-causes-of-anal-fissures

  Whether you have an anal fissure and would rather not repeat the unpleasant experience or would like to prevent the condition in the first place, understanding what causes this condition is essential. […] An anal fissure can be a painful condition and one that you certainly dont want to repeat. […] To help, the experienced team of colorectal experts at Fairfax Colon Rectal Surgery wants to focus on anal fissures in this months blog post. […] There are several ways in which an anal fissure can develop, and the following are among the more common: […] If you have chronic constipation and youre constantly straining to have a bowel movement, youre more at risk for developing an anal fissure. […] If youre dehydrated and pass a particularly hard piece of stool, it can tear the lining of your anal canal on the way out.

• #9 The Most Common Causes of Anal Fissures: Robert G Yavrouian, MD, FACS, FASCRS: Colon and Rectal Surgery

  https://www.lacolorectalsurgery.com/blog/the-most-common-causes-of-anal-fissures

  An anal fissure, which is a crack or tear in the lining of the anus, is a common but painful condition. […] Several factors can trigger anal fissures, including: […] Constipation is the leading cause of anal fissures and can result from diet, certain medications, dehydration, and lack of exercise. Hard bowel movements increase the risk of tearing the anal lining. […] Do you strain when having bowel movements? Even if you aren’t constipated, straining puts extra pressure on the anal lining, increasing the risk of a fissure. […] Between 1% and 5% of Americans have chronic diarrhea or loose stools. Diarrhea often contains more stomach acid and digestive enzymes than normal bowel movements, and the frequency at which it occurs increases the risk of anal irritation and tissue damage. […] Certain sexual activities, like anal sex and inserting objects into the anus, increase the risk of fissures. […] The anal sphincter experiences significant pressure during vaginal delivery, which can damage the delicate lining of the anus. This isn’t a risk for every pregnancy, but it’s more likely with large babies and difficult deliveries.

• #10 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  Other possible causes of anal fissure include: Persistent diarrhea, A sexually transmitted infection, such as anal herpes or chlamydia, which cause the tissues to become soft and fragile, Inflammatory bowel disease (IBD), meaning ulcerative colitis or Crohn’s disease, Trauma, for instance from rough or inadequately lubricated anal intercourse, or other insertion of foreign objects, Unusually tight anal sphincter muscles or anal spasm, Previous anal surgery, Anal cancer can have similar symptoms to benign anal fissure, Certain other cancers, e.g. leukemia. […] Often, no clear cause for an anal fissure can be found. They are associated with tight anal sphincter muscles, though the cause of this is unknown.

• #11 The Most Common Causes of Anal Fissures: Robert G Yavrouian, MD, FACS, FASCRS: Colon and Rectal Surgery

  https://www.lacolorectalsurgery.com/blog/the-most-common-causes-of-anal-fissures

  An anal fissure, which is a crack or tear in the lining of the anus, is a common but painful condition. […] Several factors can trigger anal fissures, including: […] Constipation is the leading cause of anal fissures and can result from diet, certain medications, dehydration, and lack of exercise. Hard bowel movements increase the risk of tearing the anal lining. […] Do you strain when having bowel movements? Even if you aren’t constipated, straining puts extra pressure on the anal lining, increasing the risk of a fissure. […] Between 1% and 5% of Americans have chronic diarrhea or loose stools. Diarrhea often contains more stomach acid and digestive enzymes than normal bowel movements, and the frequency at which it occurs increases the risk of anal irritation and tissue damage. […] Certain sexual activities, like anal sex and inserting objects into the anus, increase the risk of fissures. […] The anal sphincter experiences significant pressure during vaginal delivery, which can damage the delicate lining of the anus. This isn’t a risk for every pregnancy, but it’s more likely with large babies and difficult deliveries.

• #12 Causes and Prevention of Anal Fissures: Lisa A. Perryman, MD, FACS, FASCRS: Colon and Rectal Surgeon

  https://www.coloradocolonandrectalspecialists.com/blog/causes-and-prevention-of-anal-fissures

  An anal fissure is caused by a small tear in the thin, moist tissue that lines the anus. It can form when you pass hard or large stools during a bowel movement. […] Trauma to the anus and anal canal can cause anal fissures. One or more of the following factors may contribute: Long-term constipation, Straining during bowel movements, Tight anal sphincter, Anorectal scarring, Inflammatory bowel disease, Reduced blood flow to the anorectal area. […] Women are at a higher risk of developing an anal fissure after childbirth.

• #13 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

• #14 Anal Fissures: Causes and Prevention

  https://www.webmd.com/digestive-disorders/anal-fissure-causes

  An anal fissure is caused by trauma or injury that stretches your anal canal. Reasons for this can include: […] Constipation or passing large or hard stools […] Explosive or ongoing diarrhea […] Childbirth. Less often, having anal sex or putting things into your anus can overstretch the skin and cause a fissure. Too much pressure, tight anal sphincter muscles, and poor blood supply to your anus may lead to their development and poor healing.

• #15 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement. Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures. […] Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool. […] Initial minor tears in the anal mucosa due to a hard bowel movement probably occur often. In most people, these heal rapidly without long-term sequelae. In patients with underlying abnormalities of the internal sphincter, however, these injuries progress to acute and chronic anal fissures. […] The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.

• #16 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The posterior anal commissure is the most poorly perfused part of the anal canal. In patients with hypertrophied internal anal sphincters, this delicate blood supply is further compromised, thus rendering the posterior midline of the anal canal relatively ischemic. […] Pain accompanies each bowel movement as this raw area is stretched and the injured mucosa is abraded by the stool. The internal sphincter also begins to spasm when a bowel movement is passed. This spasm has two effects: First, it is painful in itself, and second, it further reduces the blood flow to the posterior midline and the anal fissure, contributing to the poor healing rate.

• #17 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement. Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures. […] Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool. […] Initial minor tears in the anal mucosa due to a hard bowel movement probably occur often. In most people, these heal rapidly without long-term sequelae. In patients with underlying abnormalities of the internal sphincter, however, these injuries progress to acute and chronic anal fissures. […] The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.

• #18 Anal Fissure Causes, Hemorrhoid, Pain, Treatment & How to Heal

  https://www.medicinenet.com/anal_fissure/article.htm

  Anal fissures are caused by trauma to the anus and anal canal. The cause of the trauma usually is a bowel movement, and many people can remember the exact bowel movement during which their pain began. The fissure may be caused by a hard stool or repeated episodes of diarrhea. Occasionally, the insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland) can result in sufficient trauma to produce a fissure. During childbirth, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm. […] Other causes of fissures are anal cancer, Crohn’s disease, and leukemia as well as many infectious diseases including tuberculosis, viral infections (cytomegalovirus or herpes), syphilis, gonorrhea, Chlamydia, chancroid (Hemophilus ducreyi), and human immunodeficiency virus (HIV). Among patients with Crohn’s disease, 4% will have an anal fissure as the first manifestation of their Crohn’s disease, and half of all patients with Crohn’s disease eventually will develop anal ulceration that may look like a fissure.

• #19 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The posterior anal commissure is the most poorly perfused part of the anal canal. In patients with hypertrophied internal anal sphincters, this delicate blood supply is further compromised, thus rendering the posterior midline of the anal canal relatively ischemic. […] Pain accompanies each bowel movement as this raw area is stretched and the injured mucosa is abraded by the stool. The internal sphincter also begins to spasm when a bowel movement is passed. This spasm has two effects: First, it is painful in itself, and second, it further reduces the blood flow to the posterior midline and the anal fissure, contributing to the poor healing rate.

• #20 Anal Fissure Causes, Hemorrhoid, Pain, Treatment & How to Heal

  https://www.medicinenet.com/anal_fissure/article.htm

  Studies of the anal canal in patients with anal fissures consistently show that the muscles surrounding the anal canal are contracting too strongly (they are in spasm), thereby generating a pressure in the canal that is abnormally high. […] The supply of blood to the anus and anal canal also may play a role in the poor healing of anal fissures. Anatomic and microscopic studies of the anal canal on cadavers found that in 85% of individuals, the posterior part of the anal canal (where most fissures occur) has less blood flowing to it than the other parts of the anal canal. Moreover, ultrasound studies that measure the flow of blood showed that the posterior anal canal had less than half of the blood flow of other parts of the canal. This relatively poor flow of blood may be a factor in preventing fissures from healing. It also is possible that the increased pressure in the anal canal due to spasms of the internal anal sphincter may compress the blood vessels of the anal canal and further reduce the flow of blood.

• #21 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The posterior anal commissure is the most poorly perfused part of the anal canal. In patients with hypertrophied internal anal sphincters, this delicate blood supply is further compromised, thus rendering the posterior midline of the anal canal relatively ischemic. […] Pain accompanies each bowel movement as this raw area is stretched and the injured mucosa is abraded by the stool. The internal sphincter also begins to spasm when a bowel movement is passed. This spasm has two effects: First, it is painful in itself, and second, it further reduces the blood flow to the posterior midline and the anal fissure, contributing to the poor healing rate.

• #22 Anal fissures: what they are, symptoms and causes – THDLAB – CO UK | THD

  https://www.thdlab.co.uk/patients/diseases/anal-fissures

  Anal fissures often appear following a micro-trauma in the anal area. The micro-trauma may be due to physical causes, such as solid stools which are too hard and voluminous or to chemical causes, such as diarrhoea and liquid stools. […] The pain caused by the anal fissure causes a contraction of the anal sphincter, the muscle that controls continence and the release of faeces (anal hypertonia). Sphincter hypertonia reduces the flow of blood to the lesion and hinders healing. This vicious circle leads to an aggravation of the problem and favours the chronic aspect of the lesion (chronic anal fissure).

• #23 Anal fissures: what they are, symptoms and causes – THDLAB – CO UK | THD

  https://www.thdlab.co.uk/patients/diseases/anal-fissures

  Anal fissures often appear following a micro-trauma in the anal area. The micro-trauma may be due to physical causes, such as solid stools which are too hard and voluminous or to chemical causes, such as diarrhoea and liquid stools. […] The pain caused by the anal fissure causes a contraction of the anal sphincter, the muscle that controls continence and the release of faeces (anal hypertonia). Sphincter hypertonia reduces the flow of blood to the lesion and hinders healing. This vicious circle leads to an aggravation of the problem and favours the chronic aspect of the lesion (chronic anal fissure).

• #24 Anal fissure: Clinical manifestations, diagnosis, prevention – UpToDate

  https://www.uptodate.com/contents/anal-fissure-clinical-manifestations-diagnosis-prevention

  Anal fissure is one of the most common benign anorectal diseases and one of the most common causes of anal pain and anal bleeding. […] Secondary causes of anal fissures are discussed separately. […] Anal fissures typically start with a tear to the anoderm within the distal half of the anal canal. The tear then triggers cycles of recurring anal pain and bleeding, which lead to the development of a chronic anal fissure in as many as 40 percent of patients. […] The exposed internal sphincter muscle within the bed of the fissure frequently spasms, which not only contributes to severe pain but also can restrict blood flow to the fissure, preventing its healing.

• #25 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

• #26 Anal Fissures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526063/

  Anal fissures are common in those with a history of constipation or hard stools, low fiber diet, trauma, and previous anal surgery. […] Causes of anal fissures commonly include constipation, chronic diarrhea, sexually transmitted diseases, tuberculosis, inflammatory bowel disease, HIV, anal cancer, childbearing, prior anal surgery, and anal sexual intercourse. […] The majority of acute anal fissures are thought to be due to the passage of hard stools, sexually transmitted infection, or anal injury due to penetration. […] Underlying conditions such as inflammatory bowel disease, tuberculosis, HIV, anal cancer, and prior anal surgery are predisposing factors to both acute and chronic atypical anal fissures.

• #27

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  Anal fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. […] Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohns disease, Ulcerative Colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer. These diseases can cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

• #28 Anal fissure: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/what-is-anal-fissure-and-what-causes-it

  An anal fissure is a tear in the lining of the anal canal, or a cut or tear in the anus region, that extends into the anal canal. It can result from constipation, anal sex, infections, and other factors. […] Damage to the lining of the anus is a common cause. […] They can be idiopathic (no known cause). […] Anal fissures can happen for a number of reasons. […] Constipation: Large, hard feces (stools) are more likely to result in lesions in the anal area during a bowel movement than soft and smaller ones. […] Diarrhea: Repeated diarrhea can cause an anal fissure to develop. […] Muscle spasms: Experts believe that anal sphincter muscle spasms may increase the risk of developing an anal fissure. […] Pregnancy and childbirth: Pregnant females assigned at birth (FAAB) have a higher chance of developing an anal fissure towards the end of their pregnancy.

• #29 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement. Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures. […] Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool. […] Initial minor tears in the anal mucosa due to a hard bowel movement probably occur often. In most people, these heal rapidly without long-term sequelae. In patients with underlying abnormalities of the internal sphincter, however, these injuries progress to acute and chronic anal fissures. […] The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.

• #30 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  Other possible causes of anal fissure include: Persistent diarrhea, A sexually transmitted infection, such as anal herpes or chlamydia, which cause the tissues to become soft and fragile, Inflammatory bowel disease (IBD), meaning ulcerative colitis or Crohn’s disease, Trauma, for instance from rough or inadequately lubricated anal intercourse, or other insertion of foreign objects, Unusually tight anal sphincter muscles or anal spasm, Previous anal surgery, Anal cancer can have similar symptoms to benign anal fissure, Certain other cancers, e.g. leukemia. […] Often, no clear cause for an anal fissure can be found. They are associated with tight anal sphincter muscles, though the cause of this is unknown.

• #31

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  Anal fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. […] Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohns disease, Ulcerative Colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer. These diseases can cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

• #32 Anal fissure – symptoms, causes, and treatments | healthdirect

  https://www.healthdirect.gov.au/anal-fissure

  An anal fissure is a small tear or split in the skin that lines the anus. […] Most anal fissures are caused by trauma (injury) to the area. This can happen: when you pass hard or large stools for example, if you are constipated […] if you have diarrhoea […] during childbirth. […] Other, less common causes of anal fissures are: inflammatory bowel disease especially Crohn’s disease […] infection with tuberculosis […] sexually transmitted infections (STIs) […] cancer.

• #33 Anal fissure – symptoms, causes, and treatments | healthdirect

  https://www.healthdirect.gov.au/anal-fissure

  An anal fissure is a small tear or split in the skin that lines the anus. […] Most anal fissures are caused by trauma (injury) to the area. This can happen: when you pass hard or large stools for example, if you are constipated […] if you have diarrhoea […] during childbirth. […] Other, less common causes of anal fissures are: inflammatory bowel disease especially Crohn’s disease […] infection with tuberculosis […] sexually transmitted infections (STIs) […] cancer.

• #34

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  Anal fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. […] Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohns disease, Ulcerative Colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer. These diseases can cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

• #35 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

• #36 Anal fissure: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/what-is-anal-fissure-and-what-causes-it

  Sexually transmitted infections (STIs): Also known as sexually transmitted diseases (STDs), these are linked to a higher risk of having anal fissures. […] Underlying conditions: Some underlying conditions, such as Crohns disease, ulcerative colitis, and other inflammatory bowel diseases may cause ulcers to form in the anal area. […] Anal sex: This can in rare instances cause anal fissures.

• #37 Anal fissure: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/what-is-anal-fissure-and-what-causes-it

  Sexually transmitted infections (STIs): Also known as sexually transmitted diseases (STDs), these are linked to a higher risk of having anal fissures. […] Underlying conditions: Some underlying conditions, such as Crohns disease, ulcerative colitis, and other inflammatory bowel diseases may cause ulcers to form in the anal area. […] Anal sex: This can in rare instances cause anal fissures.

• #38 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  Other possible causes of anal fissure include: Persistent diarrhea, A sexually transmitted infection, such as anal herpes or chlamydia, which cause the tissues to become soft and fragile, Inflammatory bowel disease (IBD), meaning ulcerative colitis or Crohn’s disease, Trauma, for instance from rough or inadequately lubricated anal intercourse, or other insertion of foreign objects, Unusually tight anal sphincter muscles or anal spasm, Previous anal surgery, Anal cancer can have similar symptoms to benign anal fissure, Certain other cancers, e.g. leukemia. […] Often, no clear cause for an anal fissure can be found. They are associated with tight anal sphincter muscles, though the cause of this is unknown.

• #39 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fissures-Causes.aspx

  An anal fissure involves stretching and tearing of the rim of the anus. It may result from several possible causes, or present in various circumstances. These include: a lot of pressure on the area, for example due to passing very hard or impacted stools […] damage or weakness to the skin, causing it to break easily. The most common cause of an anal fissure is abnormal stools or bowel movements. In particular, large or hard stools are more difficult to pass and place greater stress on the anus during bowel movements. Individuals who are constipated and need to strain to pass stools are most likely to be affected, as the impacted stool increases the risk of tearing the anal margin. An anal fissure can also sometimes occur if an individual has severe or chronic diarrhea, due to the inflamed mucosa and perianal skin. Some individuals have a spastic anal sphincter which makes it very difficult to pass normal stools without pain and tears of the anal mucosa and skin. In addition, this muscle hypertrophy leads to reduced blood supply to the skin around the anus, leading to slow healing of occasional tears and resulting in an anal fissure. Anal fissures are also more common in women following childbirth, which is estimated to account for approximately 10% of cases. This is most likely due to the straining required during childbirth that can put greater pressure on the anus and may result in an anal tear. Inflammation of the anorectal area can also increase the risk of an anal fissure developing. The inflammatory bowel condition called Crohns disease is associated with inflammation of the intestinal tract. This can lead to more pressure on the anal canal, and weaken the skin around the anal orifice, so that it is more likely to tear. In rare cases, an anal fissure may be caused by an infection of the anus, which weakens the skin due to the inflammation. This may include infections such as: HIV, Tuberculosis, Syphilis, Herpes. Individuals who engage in anal intercourse are at a greater risk of acquiring such infections and developing an associated anal fissure. Rarely, an anal fissure may develop as a result of cancer of the rectum or anus. The tumor growth probably weakens the skin or causes obstruction to the passage of stools, leaving the anus more vulnerable to tearing. There are some cases of anal fissure without a clear identifiable cause. These are referred to as idiopathic anal fissure. Both the very young and the elderly are at an increased risk of anal fissures in comparison to the general population. Infants are more likely to experience an anal fissure than other individuals, although the reason for this relationship is not clear. It appears that the first year of life is the time associated with the greatest risk of anal fissure. Conversely, elderly individuals are also more likely to be affected. This is thought to be at least in part due to reduced circulation to the rectal area, which may result in skin breakdown and an anal fissure.

• #40 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

• #41

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  Anal fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. […] Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohns disease, Ulcerative Colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer. These diseases can cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

• #42 Anal Fissure Causes, Hemorrhoid, Pain, Treatment & How to Heal

  https://www.medicinenet.com/anal_fissure/article.htm

  Anal fissures are caused by trauma to the anus and anal canal. The cause of the trauma usually is a bowel movement, and many people can remember the exact bowel movement during which their pain began. The fissure may be caused by a hard stool or repeated episodes of diarrhea. Occasionally, the insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland) can result in sufficient trauma to produce a fissure. During childbirth, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm. […] Other causes of fissures are anal cancer, Crohn’s disease, and leukemia as well as many infectious diseases including tuberculosis, viral infections (cytomegalovirus or herpes), syphilis, gonorrhea, Chlamydia, chancroid (Hemophilus ducreyi), and human immunodeficiency virus (HIV). Among patients with Crohn’s disease, 4% will have an anal fissure as the first manifestation of their Crohn’s disease, and half of all patients with Crohn’s disease eventually will develop anal ulceration that may look like a fissure.

• #43 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

• #44 Anal fissure | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/anal-fissure?content_id=CON-20157210

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis.

• #45 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  An anal fissure is a small tear in the thin, moist tissue that lines the anus. Common causes of an anal fissure include constipation and straining or passing hard or large stools during a bowel movement. […] Common causes of anal fissures include: Passing large or hard stools. Constipation and straining during bowel movements. Long-lasting diarrhea. Anal intercourse. Childbirth. […] Less common causes of anal fissures include: Crohn’s disease or another inflammatory bowel disease. Anal cancer. HIV. Tuberculosis. Syphilis. […] Factors that may increase the risk of developing an anal fissure include: Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. Childbirth. Anal fissures are more common in women after they give birth. Crohn’s disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract. This may make the lining of the anal canal more vulnerable to tearing. Anal intercourse. Age. Anal fissures can occur at any age, but are more common in infants and middle-aged adults.

• #46 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fissures-Causes.aspx

  An anal fissure involves stretching and tearing of the rim of the anus. It may result from several possible causes, or present in various circumstances. These include: a lot of pressure on the area, for example due to passing very hard or impacted stools […] damage or weakness to the skin, causing it to break easily. The most common cause of an anal fissure is abnormal stools or bowel movements. In particular, large or hard stools are more difficult to pass and place greater stress on the anus during bowel movements. Individuals who are constipated and need to strain to pass stools are most likely to be affected, as the impacted stool increases the risk of tearing the anal margin. An anal fissure can also sometimes occur if an individual has severe or chronic diarrhea, due to the inflamed mucosa and perianal skin. Some individuals have a spastic anal sphincter which makes it very difficult to pass normal stools without pain and tears of the anal mucosa and skin. In addition, this muscle hypertrophy leads to reduced blood supply to the skin around the anus, leading to slow healing of occasional tears and resulting in an anal fissure. Anal fissures are also more common in women following childbirth, which is estimated to account for approximately 10% of cases. This is most likely due to the straining required during childbirth that can put greater pressure on the anus and may result in an anal tear. Inflammation of the anorectal area can also increase the risk of an anal fissure developing. The inflammatory bowel condition called Crohns disease is associated with inflammation of the intestinal tract. This can lead to more pressure on the anal canal, and weaken the skin around the anal orifice, so that it is more likely to tear. In rare cases, an anal fissure may be caused by an infection of the anus, which weakens the skin due to the inflammation. This may include infections such as: HIV, Tuberculosis, Syphilis, Herpes. Individuals who engage in anal intercourse are at a greater risk of acquiring such infections and developing an associated anal fissure. Rarely, an anal fissure may develop as a result of cancer of the rectum or anus. The tumor growth probably weakens the skin or causes obstruction to the passage of stools, leaving the anus more vulnerable to tearing. There are some cases of anal fissure without a clear identifiable cause. These are referred to as idiopathic anal fissure. Both the very young and the elderly are at an increased risk of anal fissures in comparison to the general population. Infants are more likely to experience an anal fissure than other individuals, although the reason for this relationship is not clear. It appears that the first year of life is the time associated with the greatest risk of anal fissure. Conversely, elderly individuals are also more likely to be affected. This is thought to be at least in part due to reduced circulation to the rectal area, which may result in skin breakdown and an anal fissure.

• #47 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  An anal fissure can occur when there is overstretching of the anal canal, which causes the lining to tear. Common causes include a large, hard or otherwise traumatic bowel movement, or anal penetration. […] Anal fissure most commonly occurs due to constipation. Lots of factors may cause constipation, but the most common include: Not eating enough fiber, Not drinking enough fluids, Some medications, particularly strong painkillers, such as opioids, Not exercising or being less active, Frequently ignoring the urge to defecate, Changing diet or daily routine, Anxiety or depression, Some medical conditions, such as an underactive thyroid gland. […] During pregnancy, women often experience constipation due to the increased weight of the baby putting pressure on the rectum, the final segment of the digestive system, which stores feces until a person is ready to defecate.

• #48 Anal Fissure – Symptoms, Causes, Types, Complications, Prevention PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact

  https://www.pacehospital.com/anal-fissure-symptoms-causes-types-complications

  Anal fissures (anorectal fissure) are classified into two types based on the duration of time, they are: […] The causes for anal fissures (fissure in ano) are as follows: Chronic constipation, Chronic diarrhoea, Inflammatory bowel disease, Passage of hard stools, Anal injury, Childbearing or vaginal delivery, Eating low fibre diet, Inflammation of anus, Scratching due to pinworm Infection, Excessive wiping of the anus after stool passage, Rectal cancer. […] The risk factors of anal fissures (anorectal fissure) are as follows: Constipation: It causes hard stools to pass, which may lead to an anal tear; Diarrhoea: The anal skin is very sensitive, so diarrhoea can cause fissures by cracking/tearing the skin; Inflammatory bowel diseases (ulcerative colitis and crohn’s disease): Peri anal diseases (piles, fissures) are the common complications of inflammatory diseases due to severe symptomatic conditions such as constipation and persistent diarrhoea; Sexually transmitted diseases (HIV, syphilis etc.): Sexually transmitted infections (STIs) cause ulcerations, lesions and bleeding in the anorectal regions, possibly leading to fissures; Anal cancer: Usually, the symptoms of anal cancer are the same as fissures causing lumps, pain, and bleeding, so people with colon or anal cancer may develop fissures, but people with fissures won’t develop anal cancer; Tuberculosis (TB): TB is one of the inflammatory conditions in the anorectal region. It may cause symptoms such as itching, bleeding and discharge, which in turn causes anal fissure or fistula; Anal intercourse: Anal intercourse or inserting any objects into the anus may lead to an anal tear or crack due to the increased pressure near the anal sphincter; Pregnancy: Pregnant women may experience constipation due to hormonal changes and pressure by the foetus; Childbirth: Due to heavy contractions and pressure during labour, the women may experience anal fissures.

• #49 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement. Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures. […] Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool. […] Initial minor tears in the anal mucosa due to a hard bowel movement probably occur often. In most people, these heal rapidly without long-term sequelae. In patients with underlying abnormalities of the internal sphincter, however, these injuries progress to acute and chronic anal fissures. […] The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.

• #50 Most Common Causes Of Piles And Anal Fissure  – Yashoda Hospital

  https://www.yashodahealthcare.com/blogs/most-common-causes-of-piles-and-anal-fissure/

  Obesity is the result of this lethargic lifestyle. […] Piles are most common among adults aged 45 to 65 years. […] Piles can occur after cases of chronic diarrhea. […] Staying in a seated position for long periods can cause Piles, especially on the toilet. […] Repeatedly lifting heavy objects can lead to Piles. […] This can cause new Piles or worsen existing ones. […] Some people inherit a tendency to develop Piles. […] If youre feeling any sort of pain or some strain while defecating, the severe case of which might lead to these two above-mentioned problems. […] A low fiber diet can irritate the stomach which can lead to disturbed bowel movements and even constipation which furthermore leads to straining in the toilet causing anal fissures.

• #51 The Most Common Causes of Anal Fissures: Robert G Yavrouian, MD, FACS, FASCRS: Colon and Rectal Surgery

  https://www.lacolorectalsurgery.com/blog/the-most-common-causes-of-anal-fissures

  An anal fissure, which is a crack or tear in the lining of the anus, is a common but painful condition. […] Several factors can trigger anal fissures, including: […] Constipation is the leading cause of anal fissures and can result from diet, certain medications, dehydration, and lack of exercise. Hard bowel movements increase the risk of tearing the anal lining. […] Do you strain when having bowel movements? Even if you aren’t constipated, straining puts extra pressure on the anal lining, increasing the risk of a fissure. […] Between 1% and 5% of Americans have chronic diarrhea or loose stools. Diarrhea often contains more stomach acid and digestive enzymes than normal bowel movements, and the frequency at which it occurs increases the risk of anal irritation and tissue damage. […] Certain sexual activities, like anal sex and inserting objects into the anus, increase the risk of fissures. […] The anal sphincter experiences significant pressure during vaginal delivery, which can damage the delicate lining of the anus. This isn’t a risk for every pregnancy, but it’s more likely with large babies and difficult deliveries.

• #52 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  An anal fissure can occur when there is overstretching of the anal canal, which causes the lining to tear. Common causes include a large, hard or otherwise traumatic bowel movement, or anal penetration. […] Anal fissure most commonly occurs due to constipation. Lots of factors may cause constipation, but the most common include: Not eating enough fiber, Not drinking enough fluids, Some medications, particularly strong painkillers, such as opioids, Not exercising or being less active, Frequently ignoring the urge to defecate, Changing diet or daily routine, Anxiety or depression, Some medical conditions, such as an underactive thyroid gland. […] During pregnancy, women often experience constipation due to the increased weight of the baby putting pressure on the rectum, the final segment of the digestive system, which stores feces until a person is ready to defecate.

• #53 The Most Common Causes of Anal Fissures: Michael H Tarlowe MD: Proctologists

  https://www.michaeltarlowemd.com/blog/the-most-common-causes-of-anal-fissures

  Every year, about 250,000 people in the United States are diagnosed with anal fissures, making them a relatively common problem among people of all ages. […] An anal fissure is a small tear that develops near your anus as a result of excess stretching and pressure. […] Other causes and risk factors include: Chronic constipation, Inflammatory bowel disease, Obesity, STDs, like herpes, syphilis, or HIV, Tuberculosis, Thyroid disease. […] Hard bowel movements are the most common cause of anal fissures. […] Less commonly, an anal fissure can form as a result of diarrhea or loose bowels. […] Fissures may also form as a result of vaginal childbirth.

• #54 Most Common Causes Of Piles And Anal Fissure  – Yashoda Hospital

  https://www.yashodahealthcare.com/blogs/most-common-causes-of-piles-and-anal-fissure/

  Obesity is the result of this lethargic lifestyle. […] Piles are most common among adults aged 45 to 65 years. […] Piles can occur after cases of chronic diarrhea. […] Staying in a seated position for long periods can cause Piles, especially on the toilet. […] Repeatedly lifting heavy objects can lead to Piles. […] This can cause new Piles or worsen existing ones. […] Some people inherit a tendency to develop Piles. […] If youre feeling any sort of pain or some strain while defecating, the severe case of which might lead to these two above-mentioned problems. […] A low fiber diet can irritate the stomach which can lead to disturbed bowel movements and even constipation which furthermore leads to straining in the toilet causing anal fissures.

• #55 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  An anal fissure can occur when there is overstretching of the anal canal, which causes the lining to tear. Common causes include a large, hard or otherwise traumatic bowel movement, or anal penetration. […] Anal fissure most commonly occurs due to constipation. Lots of factors may cause constipation, but the most common include: Not eating enough fiber, Not drinking enough fluids, Some medications, particularly strong painkillers, such as opioids, Not exercising or being less active, Frequently ignoring the urge to defecate, Changing diet or daily routine, Anxiety or depression, Some medical conditions, such as an underactive thyroid gland. […] During pregnancy, women often experience constipation due to the increased weight of the baby putting pressure on the rectum, the final segment of the digestive system, which stores feces until a person is ready to defecate.

• #56 Anal Fissures – McConnell Colorectal CenterMcConnell Colorectal Center

  https://www.azcolorectal.com/treatments/anal-fissures/

  Fissures are usually caused by trauma to the inner lining of the anus. […] The typical patient is a young female taking prenatal vitamins with iron, a constipating agent, which makes large very hard stools as iron slows the movement of stool through the gastrointestinal tract. […] Another typical patient would be a postoperative patient who has been placed on narcotics for pain. […] Patients with recurrent acute anal tearing will develop a hypertrophied or tight internal anal sphincter muscles (i.e., increased muscle tone) which then exacerbates the development of anal fissures. […] An acute anal fissure occurs when a large, hard, dry bowel movement moves through the anus. […] Loose stools and diarrhea are a more common cause particularly when there is a hard small stool followed by diarrhea which rapidly propels the stool through the closed anal sphincter causing trauma or a tear of the anus. […] Other, less common, causes of an anal fissure include hemorrhoid surgery, inflammatory conditions, chronic diarrhea and certain anal infections, radiation treatment or tumors. […] Anal fissures may be acute (recent onset) or chronic (present for a long period of time).

• #57 Most Common Causes Of Piles And Anal Fissure  – Yashoda Hospital

  https://www.yashodahealthcare.com/blogs/most-common-causes-of-piles-and-anal-fissure/

  Obesity is the result of this lethargic lifestyle. […] Piles are most common among adults aged 45 to 65 years. […] Piles can occur after cases of chronic diarrhea. […] Staying in a seated position for long periods can cause Piles, especially on the toilet. […] Repeatedly lifting heavy objects can lead to Piles. […] This can cause new Piles or worsen existing ones. […] Some people inherit a tendency to develop Piles. […] If youre feeling any sort of pain or some strain while defecating, the severe case of which might lead to these two above-mentioned problems. […] A low fiber diet can irritate the stomach which can lead to disturbed bowel movements and even constipation which furthermore leads to straining in the toilet causing anal fissures.

• #58 The Most Common Causes of Anal Fissures: Michael H Tarlowe MD: Proctologists

  https://www.michaeltarlowemd.com/blog/the-most-common-causes-of-anal-fissures

  Every year, about 250,000 people in the United States are diagnosed with anal fissures, making them a relatively common problem among people of all ages. […] An anal fissure is a small tear that develops near your anus as a result of excess stretching and pressure. […] Other causes and risk factors include: Chronic constipation, Inflammatory bowel disease, Obesity, STDs, like herpes, syphilis, or HIV, Tuberculosis, Thyroid disease. […] Hard bowel movements are the most common cause of anal fissures. […] Less commonly, an anal fissure can form as a result of diarrhea or loose bowels. […] Fissures may also form as a result of vaginal childbirth.

• #59 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  An anal fissure can occur when there is overstretching of the anal canal, which causes the lining to tear. Common causes include a large, hard or otherwise traumatic bowel movement, or anal penetration. […] Anal fissure most commonly occurs due to constipation. Lots of factors may cause constipation, but the most common include: Not eating enough fiber, Not drinking enough fluids, Some medications, particularly strong painkillers, such as opioids, Not exercising or being less active, Frequently ignoring the urge to defecate, Changing diet or daily routine, Anxiety or depression, Some medical conditions, such as an underactive thyroid gland. […] During pregnancy, women often experience constipation due to the increased weight of the baby putting pressure on the rectum, the final segment of the digestive system, which stores feces until a person is ready to defecate.

• #60 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement. Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures. […] Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool. […] Initial minor tears in the anal mucosa due to a hard bowel movement probably occur often. In most people, these heal rapidly without long-term sequelae. In patients with underlying abnormalities of the internal sphincter, however, these injuries progress to acute and chronic anal fissures. […] The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.

• #61 Anal Fistulas and Fissures: Background, Pathophysiology and Etiology, Epidemiology

  https://emedicine.medscape.com/article/776150-overview

  An anal fissure is a superficial linear tear in the anoderm that is distal to the dentate line. Anal fissures are often associated with local trauma such as the passage of hard stools or anal trauma, but can also be due to secondary causes such as inflammatory bowel disease. […] While the exact etiology is often unknown, passage of hard stools and anal trauma are often associated with anal fissures. Other causes of anal fissures can be observed in patients with chronic diarrhea, during childbirth, and those with a habitual use of cathartics. […] Once a fissure is formed, ongoing pain can cause the internal anal sphincter to spasm (hypertonicity), which causes the wound edges of the fissure to pull apart, impairing healing. Local ischemia is also thought to contribute to anal fistulas, especially in the posterior quadrant where blood flow is significantly less than other quadrants.

• #62 Chronic Anal Fissures: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/chronic-anal-fissure-symptoms

  Chronic anal fissures are tears in the tissue of the anal canal that last for more than 8 weeks. […] Stress on the anus or in the anal canal is the primary cause of anal fissures. Tight or inflamed anal muscles can also lead to anal fissures. One of the most common risk factors for anal fissures is chronic constipation. […] But anal fissures are very common. Often, there is no underlying cause or known risk factors that can be identified when someone develops chronic anal fissures.

• #63 Anal fissure: Clinical manifestations, diagnosis, prevention – UpToDate

  https://www.uptodate.com/contents/anal-fissure-clinical-manifestations-diagnosis-prevention

  Anal fissure is one of the most common benign anorectal diseases and one of the most common causes of anal pain and anal bleeding. […] Secondary causes of anal fissures are discussed separately. […] Anal fissures typically start with a tear to the anoderm within the distal half of the anal canal. The tear then triggers cycles of recurring anal pain and bleeding, which lead to the development of a chronic anal fissure in as many as 40 percent of patients. […] The exposed internal sphincter muscle within the bed of the fissure frequently spasms, which not only contributes to severe pain but also can restrict blood flow to the fissure, preventing its healing.

• #64 Anal Fissure: Treatment, Symptoms, Causes, Healing, and More

  https://www.healthline.com/health/anal-fissure

  An anal fissure most often occurs when passing large or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around your anus. […] However, not all anal fissures are a sign of low-fiber diets and constipation. Poorly healing fissures or those located in a position other than the posterior and midline portion of your anus may indicate an underlying condition. […] Other causes include: straining during childbirth or bowel movements, having inflammatory bowel disease (IBD), such as Crohns disease, having decreased blood flow to the anorectal area, having overly tight or spastic anal sphincter muscles, engaging in anal sex, inserting objects into the anus. […] In rare cases, an anal fissure may develop due to: anal cancer, HIV, tuberculosis, syphilis, herpes. […] Sustained or repeated trauma to the area is the most frequent cause of anal fissures. Childbirth, anal sex, and the passing of hard stools are all common reasons for anal fissures. […] Other conditions associated with anal fissures include previous anal surgeries, inflammatory bowel disease, local cancers, and sexually transmitted infections.

• #65 Anal Fissure | Shahab Siddiqi, Colorectal Surgeon

  https://www.surgeoncolorectal.co.uk/common-conditions/anal-fissure/

  There is great debate about the causes of uncomplicated anal fissures. […] Some people maintain that the passing of a hard stool can tear the lining of the anus, but in reality we are unsure. […] What is known is that in some people there is a relatively poor blood supply to the front and rear of the back passage and, for whatever reason, an ulcer may form. […] A number of medical conditions are associated with anal fissures. […] They are very common during pregnancy and after childbirth. […] Inflammatory bowel disease can lead to unusual types of anal fissures that are very difficult to manage. […] Sometimes, an anal fissure can indicate the presence of a sexually transmitted disease. […] Occasionally people with an otherwise normal anal canal can develop fissures at both the front and rear of the anal canal, but in patients with atypical fissures and weak anal sphincter muscles, we expect to find another condition present, such as inflammatory bowel disease or an internal rectal prolapse.

• #66

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  Anal fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. […] Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohns disease, Ulcerative Colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer. These diseases can cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

• #67 [Etiology, pathogenesis and classification of anal fissure] – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8871258/

  Anal fissure is one of the most common causes of anal pain but its etiology and pathophysiology remain obscure. Many theories have been advanced to explain the origin of anal fissures but trauma of faecal mass and hypertonicity of the internal sphincter seem to be the most important factors. […] Secondary fissures may occur on a commonly lateral position as a result of inflammatory bowel disease, previous anal surgery, venereal, dermatologic, infectious or neoplastic disease.

• #68

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  Anal fissures are usually caused by trauma to the inner lining of the anus. A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause. […] Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohns disease, Ulcerative Colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer. These diseases can cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

• #69 [Etiology, pathogenesis and classification of anal fissure] – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8871258/

  Anal fissure is one of the most common causes of anal pain but its etiology and pathophysiology remain obscure. Many theories have been advanced to explain the origin of anal fissures but trauma of faecal mass and hypertonicity of the internal sphincter seem to be the most important factors. […] Secondary fissures may occur on a commonly lateral position as a result of inflammatory bowel disease, previous anal surgery, venereal, dermatologic, infectious or neoplastic disease.

• #70 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fissures-Causes.aspx

  An anal fissure involves stretching and tearing of the rim of the anus. It may result from several possible causes, or present in various circumstances. These include: a lot of pressure on the area, for example due to passing very hard or impacted stools […] damage or weakness to the skin, causing it to break easily. The most common cause of an anal fissure is abnormal stools or bowel movements. In particular, large or hard stools are more difficult to pass and place greater stress on the anus during bowel movements. Individuals who are constipated and need to strain to pass stools are most likely to be affected, as the impacted stool increases the risk of tearing the anal margin. An anal fissure can also sometimes occur if an individual has severe or chronic diarrhea, due to the inflamed mucosa and perianal skin. Some individuals have a spastic anal sphincter which makes it very difficult to pass normal stools without pain and tears of the anal mucosa and skin. In addition, this muscle hypertrophy leads to reduced blood supply to the skin around the anus, leading to slow healing of occasional tears and resulting in an anal fissure. Anal fissures are also more common in women following childbirth, which is estimated to account for approximately 10% of cases. This is most likely due to the straining required during childbirth that can put greater pressure on the anus and may result in an anal tear. Inflammation of the anorectal area can also increase the risk of an anal fissure developing. The inflammatory bowel condition called Crohns disease is associated with inflammation of the intestinal tract. This can lead to more pressure on the anal canal, and weaken the skin around the anal orifice, so that it is more likely to tear. In rare cases, an anal fissure may be caused by an infection of the anus, which weakens the skin due to the inflammation. This may include infections such as: HIV, Tuberculosis, Syphilis, Herpes. Individuals who engage in anal intercourse are at a greater risk of acquiring such infections and developing an associated anal fissure. Rarely, an anal fissure may develop as a result of cancer of the rectum or anus. The tumor growth probably weakens the skin or causes obstruction to the passage of stools, leaving the anus more vulnerable to tearing. There are some cases of anal fissure without a clear identifiable cause. These are referred to as idiopathic anal fissure. Both the very young and the elderly are at an increased risk of anal fissures in comparison to the general population. Infants are more likely to experience an anal fissure than other individuals, although the reason for this relationship is not clear. It appears that the first year of life is the time associated with the greatest risk of anal fissure. Conversely, elderly individuals are also more likely to be affected. This is thought to be at least in part due to reduced circulation to the rectal area, which may result in skin breakdown and an anal fissure.

• #71 Chronic Anal Fissures: Symptoms, Causes, and Treatment

  https://www.healthline.com/health/chronic-anal-fissure-symptoms

  Chronic anal fissures are tears in the tissue of the anal canal that last for more than 8 weeks. […] Stress on the anus or in the anal canal is the primary cause of anal fissures. Tight or inflamed anal muscles can also lead to anal fissures. One of the most common risk factors for anal fissures is chronic constipation. […] But anal fissures are very common. Often, there is no underlying cause or known risk factors that can be identified when someone develops chronic anal fissures.

• #72 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  Other possible causes of anal fissure include: Persistent diarrhea, A sexually transmitted infection, such as anal herpes or chlamydia, which cause the tissues to become soft and fragile, Inflammatory bowel disease (IBD), meaning ulcerative colitis or Crohn’s disease, Trauma, for instance from rough or inadequately lubricated anal intercourse, or other insertion of foreign objects, Unusually tight anal sphincter muscles or anal spasm, Previous anal surgery, Anal cancer can have similar symptoms to benign anal fissure, Certain other cancers, e.g. leukemia. […] Often, no clear cause for an anal fissure can be found. They are associated with tight anal sphincter muscles, though the cause of this is unknown.

• #73 Anal Fissure – Grand Ave Urgent Care

  https://grandaveurgentcare.com/patient-education/health-library?DOCHWID=uf4764

  Anal fissures are caused by injury or trauma to the anal canal. Injury can happen when: […] Fissures can also be caused by a rectal exam, anal intercourse, or a foreign object. In some cases, a fissure may be caused by a health problem, such as Crohn’s disease. […] Many experts believe that extra tension in the two muscular rings (sphincters) controlling the anus may be a cause of fissures.

• #74 Anal Fissures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526063/

  Anal fissures are common in those with a history of constipation or hard stools, low fiber diet, trauma, and previous anal surgery. […] Causes of anal fissures commonly include constipation, chronic diarrhea, sexually transmitted diseases, tuberculosis, inflammatory bowel disease, HIV, anal cancer, childbearing, prior anal surgery, and anal sexual intercourse. […] The majority of acute anal fissures are thought to be due to the passage of hard stools, sexually transmitted infection, or anal injury due to penetration. […] Underlying conditions such as inflammatory bowel disease, tuberculosis, HIV, anal cancer, and prior anal surgery are predisposing factors to both acute and chronic atypical anal fissures.

• #75 Anal Fissure: Practice Essentials, Anatomy, Pathophysiology and Etiology

  https://emedicine.medscape.com/article/196297-overview

  The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement. Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures. […] Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool. […] Initial minor tears in the anal mucosa due to a hard bowel movement probably occur often. In most people, these heal rapidly without long-term sequelae. In patients with underlying abnormalities of the internal sphincter, however, these injuries progress to acute and chronic anal fissures. […] The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.

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