Fissures result from the stretching of your anal mucosa beyond its normal capacity. Many people even avoid going to the bathroom because of the pain and discomfort it causes. A defect can be felt under the skin between the retracted edged of the internal sphincter. Anal fissures may also result from inflammatory bowel disease, surgery, or other medical treatments that affect bowel movements or the anus. Changing your diet to increase fiber and water, steps that will help regulate your bowel movements and reduce both diarrhea and constipation. Chronic fissures are also associated with raised edges, exposed internal sphincter muscle, distal sentinel tag, and hypertrophied anal papilla at the internal apex. Pressure on the vessels passing perpendicularly through the internal anal sphincter muscle during increased sphincter tone may compromise perfusion to the posterior commissure where blood flow is already sparse.
The frequent creams for topical anal use often contain corticoids that cause dermal maceration, overinfection, contact dermatitis, skin weakness and difficult healing.
This often happens when stools are hard due to constipation. J Am Coll Surg. Randomized clinical trial of botulinum toxin plus glyceryl trinitrate vs. Hard stools are more often the cause of anal fissures, but loose stools also cause the tears. The conservative treatment of fissure-in-ano.