Anal Fissure An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements Common causes of anal fissure include: Passing large or hard stools Constipation and straining during bowel movements Chronic diarrhea, Childbirth ,Crohn s disease or another inflammatory bowel disease Less common causes of anal fissures include: Anal cancer , HIV Risk factors -Infancy. Childbirth, Aging. Anal intercourse Constipation, Crohn”s disease Complications - An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. Lifestyle and home remedies Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. Adding fiber may cause gas and bloating, so increase your intake gradually. Drink adequate fluids. Fluids help prevent constipation. Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.If your symptoms persist, you ll likely need further treatment. Nonsurgical treatment Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. Topical anesthetic creams - lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. High fiber diet 25-35gms per day OTC Stool softeners to make stools easier to pass drink more fluids warm sitz baths for15 -20 minutes few times daily and after each bowel movement Lidocaine gel apply to skin around anus for pain relief Diltiazem or Nitroglycerin cream to relax the anal sphincter