Assessing pain during bowel movements and treating an anal fissure

An acute fissure often follows hard stool or straining. Pain can make the sphincter tighten, reduce blood flow to the wound and make healing more difficult.

Pain and bleeding around the anus can have other causes. An examination is important when symptoms persist, return or have not been explained.

The history and a careful inspection often provide the main clues. Further tests depend on the symptoms, age and findings, and the examination is adapted when pain is severe.

Initial care usually focuses on soft, regular stool, adequate fluids and suitable local treatment. The examination determines which ointment or additional measure may be appropriate.

If a chronic fissure does not heal despite consistent conservative treatment, further options may be considered. Previous treatment, the examination and sphincter function guide the decision.

Heavy or persistent bleeding, fever, painful swelling or rapid deterioration requires prompt medical assessment.