This is a linear anal ulcer present at the anal margin usually midline at the back, sometimes at the front. The ulcer may develop after rapid evacuation with a hard stool. Sometimes a lump is felt which is swollen skin at the end of the ulcer.
Other predisposing factors are pregnancy/delivery where the fissure is usually in the front. The ulcer is at first acute and in some cases heals but in others becomes unhealed and chronic, these require treatment.
Anal pain during and after defeacation.
Anal bleeding often drops noted on the toilet paper.
Bowels can be disturbed secondary to the pain
Lump and itch may be noticed.
Pain relief and stool softeners.
Topical GTN ointment heals 60% of fissures over 4 weeks.
Injection of Botox heals 70% of fissures.
Surgery heals 95% of fissures.
Treatment such as insertion of anal dilators can be successful but are generally not recommended due to poor success rate.
Remember: An anal ulcer that is unhealed may be a sign of Crohns disease or anal cancer, follow up is strongly recommended