Anal fissure

Analfissur und Analkrampf Symbol

Anal fissure is a painful mucosal injury in the area of the anal canal. It occurs frequently and can cause discomfort and discomfort. In this article, we take a look at the causes, symptoms and possible treatment options for this common health problem.


An anal fissure is an injury to the mucous membrane in the center of the anal canal (amoderm) that causes pain, particularly during bowel movements and constipation. Anal fissures or anal tears occur as both acute and chronic conditions. This guide provides information and medical tips and shows a new method for self-treatment with FMS dilators.

This is because a (chronic) anal spasm or severe tension in the anal sphincter muscle is often the cause of the discomfort. Relaxation of the cramped sphincter and gentle massage to strengthen the tissue are the best way to prevent a chronic condition and avoid surgery.

Causes and development

Anyone can be affected by anal fissures, but they occur particularly often between the ages of 30 and 40. Here is an overview of the causes and factors that contribute to the development of anal fissures:

  1. Defecation and toilet behavior
  2. Intestinal diseases
  3. External influences (often through sexual practices without preparation).

    1. Defecation and toilet behavior

    Probably the most common cause of anal fissures or anal cramps is hard stools and constipation. The harder the stool is, the more pressure is required for elimination, so the right diet is important. But the correct behavior during bowel movements is also important: If a woman/man is in an incorrect position, the expulsion of stool is made even more difficult and an anal fissure can develop. In this case, the clinical picture is referred to as a primary anal fissure.

    2. Diseases of the intestine

    Experience has shown that people who suffer from a (chronic) bowel disease are more prone to anal cramps and therefore anal fissures. Common diseases include hemorrhoids, permanent diarrhea, inflammation of the rectum (cryptitis), insufficient blood circulation or excessive cramping in the entire anal region. People with chronic inflammatory diseases such as Crohn's disease and ulcerative colitis also suffer more from anal fissures. In medicine, these symptoms are referred to as "secondary anal fissure" as a concomitant symptom of the above conditions.

    3. External causes

    Actions such as anal penetration without preparation, extreme sexual practices such as fisting or the insertion of unsuitable or extremely large objects into the anal area can cause painful anal cramps, injuries to the mucous membrane and anal fissures. These can also have chronic consequences.

    It should be noted that the sexual practices themselves are less likely to be the cause than a lack of caution or mindfulness when people want to experience physical boundaries (together). Especially after episodes under the influence of alcohol or drugs, help from doctors or contact with a clinic is often necessary.


    The right doctor for pain or problems in the anal region is the proctologist and the gastroenterologist. A description of the complaints and symptoms by the patient and a visual assessment including a palpation of the anal area by the doctor is usually sufficient for a diagnosis.

    Very often the fissure appears at position 6 o'clock (bottom) and then runs longitudinally to the center, i.e. near and parallel to the coccyx, rarely at 12 o'clock (top) and very rarely at other positions of the sphincter up to the mucosa. Palpation (by dignostic palpation) reveals a thickening, possibly also a very painful ulcer. Tension in the sphincter muscle, which can go as far as anal spasm, is also frequently noticed.

    When making the diagnosis, hemorrhoids and anal vein thrombosis must be ruled out. Occasionally, doctors perform a proctoscopy (rectoscopy) under local anesthesia - usually after the acute phase - to rule out other diseases. If the pain lasts up to six weeks, the fissure is still classified by doctors as "acute", after which the problem is described as "chronic". A chronic anal fissure also has a slightly different appearance: the edges of the wound are already (partially) scarred due to the periodic cramps. In addition, a swelling can be seen and sometimes also a so-called mariscus or skin fold.

    Analfissur Darstellung

    Symptoms of anal fissure

    The first clear symptoms are usually sharp or burning pain during bowel movements, accompanied by bright red, i.e. fresh bleeding. The discomfort continues even after going to the toilet and the anus can also become itchy and weepy afterwards. If these symptoms persist for several days, it often leads to a spiral of suffering: out of fear of further pain, the patient tries to delay bowel movements. This in turn leads to even more difficult defecation and even more danger for the anal sphincter. The fissure enlarges due to the constipation, the pain intensifies and an anal spasm develops. This reduces the blood flow and in turn increases the constipation, which makes healing even more difficult and so on.

    Treatment of anal fissures and anal tears

    FMS dilators are ideal for efficient and at the same time very gentle treatment. Here you can find out exactly how FMS dilators work and are used for anal fissures.

    An important part of the treatment for anal diseases is always to avoid constipation and to ensure smooth stools. Some doctors prescribe medication such as laxative suppositories in combination with pain-relieving ointments. Instead of medication, smooth stools can also be achieved with home remedies: Foods with lots of fiber such as whole grain products, cereals, potatoes, vegetables, especially legumes, fruit, especially dried plums and plenty of fluids are recommended. In contrast, sweets such as cakes and chocolate should be avoided. Behavior during bowel movements is also important: avoid frantic pushing or pressing under time pressure, take your time.

    Auch die richtige Hygiene ist wichtig: Nach dem Abwischen das Reinigen mit Wasser oder feuchtem Waschlappen. Auf feuchtes Toilettenpapier solltest du verzichten, weil es meist die wichtige Hautflora zerstört. Um die Haut geschmeidig zu halten und die Wundheilung zu begünstigen, solltest du eine Salbe verwenden.

    The above measures are essentially the same as those explained in detail in our guide to treating hemorrhoids. If the symptoms have not improved after six weeks, an operation can be performed in a clinic, known as a fissurectomy. In this treatment, the skin changes around the fissure are removed, leaving a fresh wound that usually heals well. But this does not have to happen:

    The most important measure in the treatment of anal fissure, anal tear or anal cramp is to reduce the permanent pressure of the anal sphincter by releasing the tension.

    Various ointments that you apply several times a day only have a slight external effect. A modern (and expensive) type of treatment is the injection of Botox into the sphincter muscle. Ointments and Botox only combat the symptoms, but do not preventively change the physical or psychological disposition. These can only be changed through active treatment, i.e. through the patient's own active treatment.

    Relaxation of the sphincter muscle with dilators

    Dilatation (stretching) of the anus with dilators (originally: dilators) directly addresses the cause of the problem. In addition, the treatment can be carried out by those affected without contact with a doctor, i.e. at any time and entirely according to their personal state of mind.

    • The conical (thickening) shape of conventional dilators causes pressure the deeper the dilator is inserted. This can cause a fissure to break open again.
    • Materials such as silicone or plastic are not particularly slippery
    • The size selection is too coarse. The treatment of anal fissures in particular requires a very fine adjustment of the size.

    The alternative: therapy with FMS dilators

    Dilatoren Set bei Analfissur


    The differences to conventional dilators:

    • Streamlined shape instead of wedge shape - they glide smoothly into the body
    • Made of extremely smooth borosilicate glass instead of silicone - considerably less friction
    • 24 sizes for exact adaptation to the respective requirements.

    These special properties result in an extremely gentle but very efficient application.

    As a certified medical product, its effectiveness is proven. Borosilicate glass is 100% hygienic, durable and sustainable and, unlike plastics, is particularly easy to clean.

    FMS dilators made of glass are also suitable for the treatment of:

    • Hemorrhoids
    • Incontinence
    • Vaginismus
    • as well as for prostate massage.

    Frequently asked questions & answers

    What is an anal fissure?

    This refers to a tear in the mucous membrane of the anus, usually at the central upper part of the anus.

    What are the typical symptoms of an anal fissure?

    There is stabbing pain during and after bowel movements as well as the resulting bleeding, which is visible directly on the stool or on the toilet paper. Fear of pain often leads to the suppression of bowel movements. This results in harder stools, which aggravate the anal fissure when passed - a vicious circle.

    What to do with an anal fissure?

    First of all, you should ensure that you have a soft bowel movement, which requires sufficient drinking and an adequate diet. The sitting position on the toilet should be correct. Medication includes creams that numb and relieve cramps and Botox injections. Gentle stretching (flexibilization) of the anus is helpful as self-therapy.

    What is the cause of an anal fissure?

    Possible causes are frequent postponement of going to the toilet when there is an urge to defecate. This results in hard stools, which are eventually "squeezed out" in an unfavorable sitting position. An anal fissure can also occur as a result of a chronic bowel disease or as a side effect of chemotherapy. Other causes include careless sexual practices and extreme tension due to psychological trauma.

    Is surgery necessary for an anal fissure?

    No, not necessarily, because there are various other methods of successfully treating an anal fissure medically, naturopathically or by yourself. If it persists for longer than three months, it is described as chronic. As a rule, surgery is then recommended.

    Hera Schulte Westenberg
    Hera Schulte Westenberg

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